Source: VIRGINIA POLYTECHNIC INSTITUTE submitted to NRP
TAILORED WORKSITE WEIGHT-LOSS PROGRAMS
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
HATCH
Reporting Frequency
Annual
Accession No.
0222461
Grant No.
(N/A)
Cumulative Award Amt.
(N/A)
Proposal No.
(N/A)
Multistate No.
(N/A)
Project Start Date
Jul 1, 2010
Project End Date
Jun 30, 2015
Grant Year
(N/A)
Program Code
[(N/A)]- (N/A)
Recipient Organization
VIRGINIA POLYTECHNIC INSTITUTE
(N/A)
BLACKSBURG,VA 24061
Performing Department
Human Nutrition & Foods
Non Technical Summary
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 worksites, 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 study that compares the reach and effectiveness of two worksite weight loss programs delivered in 16 worksites each. One is an internet-based intervention with monetary incentives to reduce the weight of overweight and obese employees. The other includes the same nutrition and exercise plans, but does not provide regular internet components or financial incentives. Participants in the internet and financial incentive intervention will receive frequent e-mail supports that help with goal setting, regular weigh-ins, and incentives based on percent of original body weight lost at the end of each quarter over the 12-month program. Our study will help us understand how many people join these types of programs and how well the programs help employees lose weight. We will also look at if each program influences things like work productivity and quality of life for the employees that participate.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
6096010302010%
7036010302030%
7246010302030%
9016010302030%
Knowledge Area
703 - Nutrition Education and Behavior; 724 - Healthy Lifestyle; 901 - Program and Project Design, and Statistics; 609 - Economic Theory and Methods;

Subject Of Investigation
6010 - Individuals;

Field Of Science
3020 - Education;
Goals / Objectives
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 low intensity internet-delivered knowledge control. The primary study objectives are to: 1. Determine, using a cluster (worksite) group randomized design, if the INCENT intervention will produce objectively verified decreases in body weight in the short term (6 months) and enhance longer-term (12 months) weight control for overweight and obese employees when compared to control. 2. Determine the reach (participation rate and representativeness), adoption (representativeness of worksites that participate), implementation, and sustainability of the INCENT intervention. 3. Evaluate the cost and cost effectiveness of each intervention arm based on: A) cost per 5% reduction in body weight, B) cost per unit changes in productivity and absenteeism. We also have secondary objectives to determine: 4. The potential effectiveness of the INCENT intervention to sustain weight loss at 18 and 24 months post baseline assessment. It is hypothesized that the INCENT intervention with additional relapse prevention information will lead to sustained weight loss. 5. Changes in self-efficacy, perceived support, the worksite environment and utilization of community resources for healthy weight control, and the extent to which these act as mediators of treatment outcomes. 6. Changes in physical activity and dietary behavior assessed by brief validated behavioral measures. 7. Changes in indicators of work productivity and presenteeism using the Health and Work Performance Questionnaire. The achievement of these goals, while scientifically rigorous will also result in providing healthful eating and physical activity education to approximately 2000 adult Virginias. There is no major economic development objective to the project, however the grant funding does provide salary support for 3 full time research staff/faculty over a 5 year period.
Project Methods
We selected a group randomized controlled trial design to allow us to determine the effectiveness of the individually targeted and incentives based computer mediated intervention. Due to the clustering of participants within worksites and the potential for intervention contamination via drift, individual participants cannot be randomized into conditions; instead, randomization occurs at the worksite level. Thirty-two worksites will be randomly assigned to either INCENT or control. Randomization occurs following an initial health status assessment of the employee population that will provide information and assessment for all worksite employees regardless of interest in weight loss or study participation. Repeated measures on the primary and secondary outcome variables are completed at baseline, 6 months, 12 months, 18 months, and 24 months following baseline assessments for each wave. Participants are recruited for the weight loss and maintenance study from the worksites with introductory presentations and registration offered over a two-week period at multiple times of the day to accommodate for workers on varying shifts. Registration sessions include the baseline assessment of BMI, physical activity, nutrition, and proposed individual level mediators of behavior change. Baseline assessment of the worksite environment is also completed prior to the implementation of the intervention strategies. Environmental assessments include a detailed evaluation of programs, policies, and practices in place that promote healthy eating and physical activity. In addition to determining the effectiveness of the interventions described in this proposal we are also interested in examining the potential reach, adoption, implementation, and program sustainability factors. Issues such as translatability and public health impact have been identified as critical yet have been given relatively little attention when compared to the reporting of efficacy. Given the intent of NIH to develop interventions that will have a public health impact on the overweight and obesity epidemic--and can ultimately be applied in practice--the research design and methods proposed include a strong emphasis on understanding the external validity of the project while maintaining a high level of experimental control and theoretical understanding.

Progress 07/01/10 to 06/30/15

Outputs
Target Audience: Nothing Reported Changes/Problems:The PD is no longer employedatVirginia Tech. We were unable to obtain any information on this project to report onfor this reporting period. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? N/A

Publications


    Progress 10/01/13 to 09/30/14

    Outputs
    Target Audience: Obesity researchers, policymakers, and the general public. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? One post-doctoral trainee and 2 graduate students contributed to the completion of data verification, and assisted with the development of publications and presentations. As a result they gained new skills in data management and analysis and in the dissemination of research findings. How have the results been disseminated to communities of interest? We have reported all of the findings back to the orginal worksites that participated in the trial and now are focusing on disseminating our findings to the scientific community. What do you plan to do during the next reporting period to accomplish the goals? Our main focus is now on writing up the longer-term findings of the study. We have a number of manuscripts in preparation including the primary outcome paper that we report on the reach and effectiveness of the two study interventions over a 2 year period. We also have plans to complete our papers on cost assessment and social networks as they related to weight loss success. Finally, we are planning a follow-up NIH grant proposal that will be submitted over the next reporting period.

    Impacts
    What was accomplished under these goals? To date we have made progress across a number of study aims. First, we have completed the analysis of the short term effectiveness of the intervention (Aim 1). Second, we have determined the participation and retention rates across sites and by intervention condition as well as determining the representativeness of study participants to the population of eligible employees in each worksite (Aim 2). We have recently completed the analyses of the longer-term weight loss outcomes (i.e., 12 months, Aim 1; 18 & 24 months, Aim 4) and have collected, but not analyzed the cost effectiveness of each intervention based on the cost 5% weight loss (Aim 3). The 18 and 24 month follow-up data has been collected and cleaned and the preparation of a manuscript that includes these data points as well as the 12 month data point is in development (Aim 4). We recently completed the cleaning of the worksite audit data and participant psychosocial data, but have not completed the analyses for Aim 5. We have compared the two interventions and examined differences in eating and physical activity behavior at 6 months (Aim 6).We have also developed a manuscript addressing changes to presenteeism and absenteeism (Aim 7). RESULTS Aim 1- Effectiveness findings The results at 12 months (program completion) were similar to those we reported in our previous progress report. Participants in the INCENT maintained the modest reduction in BMI and weight loss observed at 6 months (-2.32 lbs., p<0.001). By 12 months, LMW participants also showed significant changes in weight (-1.88 lbs., p<0.001). However, the difference in weight loss and BMI reduction at 12 months between INCENT and LMW groups were not statistically significant. Additionally, when using linear probability models to investigate the treatment effect on achieving 5% weight loss at 12 months, both the INCENT group and LMW group saw a similar proportion of successful participants (14.44% vs. 12.79%, p=NS). Aim 2- Reach findings Reach was operationalized as the number, proportion and representativeness of study participants when compared to the worksite as a whole. The median worksite size was 290 employees and employee completion rates of the BHS ranged from 20 to 95 percent, with a median of 63 percent of employees completing the assessment. The completion rate did not differ by condition. Across all worksites the median proportion of the total employee population that enrolled was 23 percent with a proportional reach ranging from 10 percent to 38 percent of the workforce. When considering only eligible employees based on the proportions projected by the BHS, the median enrollment was 30 percent with a proportional reach ranging from 16 percent to 47 percent of employees. On average, the mean percent of eligible employees enrolled at LMW worksites was 27 percent compared to 37 percent of eligible employees at worksites assigned to INCENT. This reflects a 37 percent higher average participant rate at incentaHEALTH worksites (p<.0001). Regardless of condition, when comparing participants to employees that completed the BHS, but did not enroll--the participant sample was significantly older, more likely to be female, more likely to be Caucasian, and have higher education and household income. However, LMW sites were less likely to recruit African American (p<.05) or lower income employees (p<.05), but more likely to recruit employees with more positive eating habits. Conversely, INCENT participants were more likely to report lower health status (p<.05) prior to participating in the program. Aim 3- Cost findings Collection of cost data completed in 2014 and will analyzed and disseminated in a peer-reviewed manuscript in 2015. Secondary Aim 4- Maintenance of weight loss findings The pattern of weight loss results remained relatively unchanged at 18 and 24 month follow-up. Participants in the INCENT group maintained the modest, yet significant amount of weight loss at 18 (-1.73 lbs., p<0.01) and 24 months (-1.73 lbs., p<0.001). Participants in LMW also maintained and reduced weight further (but not significantly) at 18 (-1.95, p<0.01) and 24 months (-2.32 lbs., p<0.001). The differences between conditions were not statistically significant. The proportion of participants that reached a 5% weight loss, based on the total number of participants enrolled, was also maintained. That is 14.4% and 14.5% of INCENT participants maintained a 5% weight loss at 18 and 24 months, respectively. The proportion of those who lost 5% of initial body weight in the LMW group was 15.0% and 15.3% at 18 and 24 months, respectively. These proportions were not significantly different between conditions. Secondary Aim 5- Changes in psychosocial and worksite environment variables These data were cleaned in 2014 and will be reported in planned manuscripts in 2015. Secondary Aim 6- Changes in physical activity and diet behaviors Participants in both groups showed statistically significant improvement in fruit, vegetables and fiber consumption; reduced fat intake; increased dietary fiber intake; reduced SSB intake; and increased moderate and vigorous physical activity behavior at 6 months follow-up. Additionally, participants in the INCENT group showed a statistically significant increase in water consumption, while LMW group showed no change at 6 months follow-up. Participants in the INCENT group had greater improvement in fruit, vegetables and fiber consumption, and increased dietary fiber intake than LMW participants. However, the differences in reduced fat intake; reduced SSB intake; increased water consumption; and moderate and vigorous physical activity behavior at 6 months between INCENT and LMW groups were not statistically significant. Furthermore, INCENT participants showed greater improvement in meeting the 5-a-day servings of fruits and vegetables recommendations at 6 months than LMW participants. By 12, 18, and 24 months most of the between group differences were reduced. Participants in the INCENT group reported 3.18, 3.25, and 3.24 servings of fruits and vegetables at 12, 18, and 24 months, respectively. While each of these reflected a significant increase from baseline, they were no different from changes made by participants in LMW. Fiber intake followed the same pattern. In addition, the differences in reduced fat intake; reduced SSB intake; increased water consumption; and moderate and vigorous physical activity behavior at 12, 18, & 24 months between INCENT and LMW groups were not statistically significant. INCENT participants showed greater improvement in meeting the 5-a-day servings of fruits and vegetables recommendations (3% vs. 0%, p<0.05 ) at 18 months than LMW participants. There were few other differences between conditions. Secondary Aim 7- Changes in worker presenteeism We found no differences between conditions in absenteeism or presenteeism. We, therefore, followed previously published protocols by pooling two intervention arms into one sample to examine the relationship between presenteeism and absenteeism based on employee weight loss. At baseline, participants reported losing 5.18 hours (+51.64) over the previous four weeks. By post-program, absolute absenteeism increased to 8.60 hours (+55.90). Absolute presenteeism at baseline was 84.5%, and relative presenteeism was above 1.0. Absolute presenteeism decreased at post-program to 81.5%. Relative presenteeism, however, increased from baseline (1.16 (+.32) to 1.18 (+.46) at post-program. None of these differences were statistically significant (p>0.05).

    Publications

    • Type: Journal Articles Status: Published Year Published: 2014 Citation: Almeida FA, Wall S, Glasgow RE, Linnan L, Davy B, Hill J, You W, Estabrooks PA. (2014) What types of worksites participate in weight loss trials? REFACS (online); 2(2):121-28
    • Type: Journal Articles Status: Published Year Published: 2014 Citation: Almeida FA, Wall SS, You W, *Harden SM, Hill JL, *Krippendorf BE, Estabrooks PA. (2014). The association between worksite physical environment and employee nutrition, and physical activity behavior and weight status. Journal of Occupational and Environmental Medicine, 56, 779-784.
    • Type: Journal Articles Status: Accepted Year Published: 2015 Citation: Almeida FA, You W, Harden SM, Allen KC, Davy BM, Glasgow RE, Hill JL, Linnan LA, Wall SS, Yenerall J, Zoellner, JM, Estabrooks PA. (in press) Effectiveness of a Worksite-based Weight Loss Randomized Controlled Trial: The WORKSITE Study. Obesity.
    • Type: Journal Articles Status: Published Year Published: 2014 Citation: Davy BM, You Wen, Almeida FA, Wall S, Harden SM, Comber D, Estabrooks PA (2014). Impact of Individual and Worksite Environmental Factors on Water and Sugar-Sweetened Beverage Consumption Among Overweight Employees.Preventing Chronic Disease, 11:130207. DOI: http://dx.doi.org/10.5888/pcd11.130207.
    • Type: Journal Articles Status: Published Year Published: 2014 Citation: Estabrooks PA, *Bhagat MS, *Almeida FA, *Davy B, and *You W (2014). Understanding the impact of a weight loss program: The roles of reach, retention, and effectiveness. REFACS (online); 2(2):99-105.


    Progress 10/01/12 to 09/30/13

    Outputs
    Target Audience: Obesity researchers, policymakers, and the general public. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? One post-doctoral trainee and 3 graduate students contributed to the completion of data collection, data verification, and assisted with the development of publications and presentations. As a result they gained new skills in data management and analysis and in the dissemination of research findings. How have the results been disseminated to communities of interest? Yes, we provided initial reports to worksites as they completed the trial. What do you plan to do during the next reporting period to accomplish the goals? We plan to finish the reporting across the longer-term and cost objectives described above.

    Impacts
    What was accomplished under these goals? We have completed our analysis of the reach of the INCENT program when compared to the comparison intervention (Objective 2). The median worksite size was 290 employees and employee completion rates of the brief health survey (BHS) that was completed before the weight loss study was announced ranged from 20 to 95% with a median of 63% of employees completing the assessment. The completion rate did not differ for Livin’ comparison worksites (63%) when compared to INCENT sites (62%). Based upon BHS responses, worksites varied from 49 to 88% in the proportion of employees that were overweight or obese (i.e., BMI ≥25) with a median of 74%; a median rate that was identical for sites randomly assigned to each condition. Across all worksites the median proportion of eligible employees that enrolled in the weight loss program was 30% with a proportional reach ranging from 16% to 47% of eligible employees. When comparing basic demographic characteristics of the employees across worksites and by condition, those worksites randomly assigned to the comparison intervention had employees that were less likely to be female, more likely to be Caucasian, less likely to be African American, and less likely to have at least some college education than those assigned to IncentaHEALTH. On average, 27% of comparison worksite employees enrolled (with a median of 28%) while 37% of eligible employees at worksites assigned to INCENT enrolled (with a median of 42%). This reflects a 37% higher average participant rate (and a 50% higher median participation rate) at INCENT worksites . Comparison sites retained, on average, 77% of enrolled participants at 6-months while INCENT retained, on average 79%. No statistically significant differences were found between conditions for retention rate at 6 months. When comparing program participants and non-participants that completed the BHS, the participant sample was significantly more likely to be female, more likely to be Caucasian, and have higher education and household income. This pattern of results is similar when comparing all program participants to (i.e., regardless of BHS completion) to non-participants who completed the BHS. When comparing program participants who completed the BHS with those who did not, those who did not complete the BHS were significantly more likely to be Hispanic or African American and less likely to be Caucasian, but no clear pattern related to education or income emerged. We have also collected all of the study data on the 1780 study participants and have verified the data through a number of quality checks over the previous year. We have analyzed the 6 month outcome data (Objective 1) and discovered modest results. Using an intention to treat analysis (I.e., considering those who dropped out as being unsuccessful) The participants in the INCENT intervention lost a small amount of weight over 6 months (approxmiately 2 pounds, on average). Those in the information only comparison group did not change their weight significantly, but showed a trend in weight gain of about 1 pound on average. The 3 pound difference between the groups was not statistically significant. Interestingly though, approximately 14% of the participants lost a clinically signficant 5% or more of their inital body weight in the INCENT group while 9% did in the comparison group. This difference approach wassignificant. Finally, when comparing only overweight participants (i.e., not including obese), the proportion of those acheiving 5% weight loss increased to 16 percent for those in INCENT compared to 8% for those in the comparison group. This difference was statistically significant. Participants in both groups showed statistically significant improvement in fruit, vegetables and fiber consumption; reduced fat intake; increased dietary fiber intake; reduced SSB intake; and increased moderate and vigorous physical activity behavior at 6 months follow-up. Additionally, participants in the INCENT group showed a statistically significant increase in water consumption, fruit, vegetables and fiber consumption, and increased dietary fiber intake when compared to the information only participants.

    Publications

    • Type: Journal Articles Status: Under Review Year Published: 2013 Citation: Almeida, F.A., Davy, B., Glasgow, R.E., Linnan, L., Hill, J., Wall, S., Xu, S., You, W., and Estabrooks, P.A. (under review) What types of worksites participate in weight loss trials? Saude Coletiva
    • Type: Journal Articles Status: Under Review Year Published: 2013 Citation: Estabrooks, P.A. & Almeida, F.A. (under review). Using the RE-AIM framework to Evaluate Health Promotion Interventions. Saude Coletiva
    • Type: Journal Articles Status: Under Review Year Published: 2013 Citation: Estabrooks, P.A., Bhagat, M.S., Almeida, F.A., Davy, B., and You, W. (under review). Understanding the impact of a weight loss program: The roles of reach, retention, and effectiveness. Saude Coletiva
    • Type: Journal Articles Status: Accepted Year Published: 2013 Citation: Davy B., W. You, F. Almeida, S. Wall, S. Harden*, D. Comber*, P. Estabrooks. Impact of individual and worksite environmental factors on water and sugar-sweetened beverage consumption among overweight and obese employees. Prev Chron Dis, In Press (Dec 2014).
    • Type: Journal Articles Status: Under Review Year Published: 2013 Citation: Hashemi A., W. You, K. Boyle, C. Parmeter, B. Kanninen, P. Estabrooks. "What, When, and How Much: The Search for Financial Incentive Designs to Enhance Participation (Reach) in Weight Loss Programs" Contemporary Economic Policy.
    • Type: Journal Articles Status: Under Review Year Published: 2013 Citation: Almeida FA, Wall SS, You W, Harden SM, Hill JL, Krippendorf BE, Estabrooks PA. (under review)The association between worksite physical environment and employee nutrition, and physical activity behavior and weight status. Journal of Occupational and Environmental Medicine
    • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: Estabrooks P. [Pres]. February 2013. Translational Science in the Behavioral Domain: More interventions please... but enough with the efficacy! Keynote talk delivered at the Australasian Society of Behavioral Health and Medicine. Newcastle, Australia
    • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: Yenerall J.* [Pres], W. You, F. Almeida, S. Harden, B. Davy, J. Hill, P. Estabrooks. June 2013. "It's More than just BMI: Capturing the Full Effect of an Incentivized Weight Loss Program on Participants' Overall Well Being" Poster presentation at Virginia Tech Fralin Translational Obesity Research Center 1st Biennial Conference, Blacksburg, VA, Jun 17-18, 2013
    • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: Estabrooks P. [Pres], W. You, F. Almeida, L. Linnan, S. Wall, B. Davy, J. Hill, J. Zoellner. May 2013. Assessing Reach in Worksite Weight Loss Programs. Presentation as part of a symposium at the annual meeting of the International Society for Behavioral Nutrition and Physical Activity. Ghent, Belgium
    • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: HILL J. [Pres], S. Harden, F. Almeida, P. Estabrooks. June 2013. Does social capital and social cohesion enhance retention in a worksite weight loss program? Presentation at the annual meeting of the International Society for Behavioral Nutrition and Physical Activity. Ghent, Belgium
    • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: You W. [Pres], Y. Yuan*, K. Boyle, S. Richard, B. Kanninen, F. Almeida, S. Wall, P. Estabrooks. July 2013. How to Best Engage Obese Adults in Weight Loss Programs: A Closer Look at Financial Incentive Designs. Selected Paper Presentation at the International Health Economics Association (iHEA) 9th World Congress on Health Economics, Sydney, Australia, July 7-10, 2013.
    • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: ZOELLNER J. [Pres], W. You, F. Almeida, K. Allen*, S. Harden*, P. Estabrooks. May 2013. Does employee health literacy status influence enrollment, retention, and success in a worksite weight loss program? Oral presentation at the International Society of Behavioral Nutrition and Physical Activity. Ghent, Belgium, May 2013.


    Progress 10/01/11 to 09/30/12

    Outputs
    OUTPUTS: Over the previous year, we completed the delivery of the interventions to all 28 worksites (1 site discontinued at 6 months - control group, 1 site discontinued at 12 months - intervention group), with 14 worksites being randomized to the intervention group and 14 to the control group. These worksites included 4 call centers, 3 hospital or medical facilities, 7 governmental agencies, 6 manufacturing companies, 4 small colleges, 1 law firm, 1 marketing firm, 1 engineering firm, and 1 mental health center. A total of 1,805 employees were enrolled in the research study. The study design incorporates the RE-AIM model of evaluation. A brief health survey (BHS) with general demographic information and health related items was developed and delivered to all employees from worksites participating in the study to measure participation rate and representativeness. The BHS was administered to 39 worksites with 7,764 employees having completed the survey (Overall 62 percent participation rate). Of those that moved to the intervention phase of the project the overall participation rate was 71 percent. The 12-month, 18-month, and 24-month follow-up visits continued throughout Year 5. To date 1268 participants from 27 worksites (1 worksite dropped before 6-month completion) have completed the 6-month follow-up visits, 1072 from 27 worksites have completed the 12-month follow-up visits, 924 from 27 worksites have completed the 18-month follow-up visits, and 844 from 25 worksites have completed the 24-month follow-up visits. Finally, cost data for the detailed economic analysis of the project are being continuously collected and reported by project staff on specially developed spreadsheets to enable assessment of intervention cost per 5percent reduction in body weight and per unit changes in productivity and absenteeism. Maintenance assessment at the 18-month and 24-month follow-up visits continued through Year 5. Over the previous year we have implemented the research necessary to address our Research Supplement to Promote Diversity in Health-Related Research Program: 3R01DK071664-04S1. This supplement awarded 2-years of support for Dr. Fabio Almeida to further develop his research career as a young scientist under the mentoring of Dr. Estabrooks and to conduct a research study. The purpose of this study is to determine the mechanisms by which social networks impact successful participation in a weight loss program. A total of 528 participants completed the social network analysis survey representing a 67 percent response rate from the entire employee population. Initial data analysis is under way. We are currently also supporting three graduate assistants on the project who have been involved in data collection, reduction, and analysis. PARTICIPANTS: Nothing significant to report during this reporting period. TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

    Impacts
    When compared, based upon worksite random assignment, the control and intervention worksites did not differ on any Brief Health Survey variable (e.g., physical activity level, BMI, eating, demographics). However, the control sites recruited, on average, 26 percent of eligible employees while the intervention sites recruited 37 percent. The difference of 11 percent is statistically significant (p less than .001). The reach study sample reflects the characteristics of employees across the 28 worksites who completed the brief health survey (n=3706). A number of comparisons are made based on this information. First, we compared those eligible who agreed to participate in the study that had also completed the brief health survey (n=1124) to those who did not enroll in the study, but did complete the brief health survey (n=2582). From these comparisons we found that there were a higher proportion of women, Caucasians, higher educated employees in the group that agreed to participate than in the group that did not. There was also a lower proportion of lower income and educated employees as well as Asian and employees who indicated 'other' for race in the employee group that agreed to participate. Finally lower income employees were less likely to participate and those in highest income category were more likely to participate. Second, we compared those who enrolled in the study and completed the BHS with those who enrolled in the study but had not completed the BHS (n=539). The proportion of Latino/Hispanic employees who enrolled in the program without having completed the BHS was significantly higher than in the group of employees who had both enrolled and completed the BHS. The same was true for employees who indicated they were African American or other on race and the lowest and highest education levels and lowest income employees. The opposite was true for the proportion of Caucasians. Third, we compared those who agreed to participate in the BHS with those who enrolled in the study but did not complete the BHS. A number of differences in the proportion of women, Latino/Hispanic, and racial categories were identified. In this case differences in proportions based on education and income were minimal. Fourth, we compared all of those who enrolled in the study (i.e., with and without completing the BHS) to those who completed the BHS but did not participate in the study. We feel this is highest quality comparison for representativeness. The proportion of women, different education and income levels were significantly different. However, race was not significantly different between the groups. In summary, our reach analyses are completed and demonstrate that the incentives-based program was superior to the non-incentives based program in proportional reach (i.e., 26 vs 37 percent). The incentives did seem to improve racial representativeness, but did not improve representativeness in education and income.

    Publications

    • No publications reported this period


    Progress 10/01/10 to 09/30/11

    Outputs
    OUTPUTS: We recruited 39 worksites, with 2 worksites currently receiving the interventions, 25 worksites having completed the interventions, 11 worksites that completed the brief health survey, but did not have internal support to continue to the intervention phase of the project, and 1 worksite that decided to discontinue participation in the project at the 6-month assessment point. Furthermore, participant study enrollment was completed at the beginning of Year 4. These worksites included 4 call centers, 3 hospital or medical facilities, 7 governmental agencies, 6 manufacturing companies, 4 small colleges, 1 law firm, 1 marketing firm, 1 engineering firm, and 1 mental health center. A total of 1,806 employees were enrolled in the research study. The study design incorporates the RE-AIM model of evaluation. A brief health survey (BHS) with general demographic information and health related items was developed and delivered to all employees from worksites participating in the study to measure participation rate and representativeness (Reach). The BHS was administered to 39 worksites with 7,764 employees having completed the survey (Overall 62% participation rate). Of those that moved to the intervention phase of the project the overall participation rate was 71%. The BHS data will be used to determine the representativeness of the participants in the intervention with the overall workforce and be used to calculate the proportion of the worksite that would be eligible to participate in the study. Worksites' reasons for non-participation have been collected to measure Adoption. A manual of worksite and employee recruitment and intervention delivery procedures has been created and is continually being updated to assess Implementation. Also, all participant intervention contacts are being monitored for timeliness and quality of completion. Effectiveness assessment began September 10, 2008 (Year 2) when the employees recruited in March 2008(our first month of intervention delivery) were eligible for their 6-month follow-up visits, as did the examination of the relationship between the INCENT intervention and objectively verified decreases in body weight in the short term (6 months). The 12-month, 18-month, and 24-month follow-up visits continued throughout Year 4. To date 1268 participants from 27 worksites have completed the sudy. Research Supplements to Promote Diversity in Health-Related Research Program: 3R01DK071664-04S1 Over the past year we were also awarded a 2-year supplement for Dr. Fabio Almeida to further develop his research career as a young scientist under the mentoring of Dr. Estabrooks and to conduct a research study. The purpose of this study is to determine the mechanisms by which social networks impact successful participation in a weight loss program. To date 373 participants have completed the social network analysis survey representing a 70% response rate from the entire employee population. Initial data analysis is currently under way with the first proposed manuscript being finalized for submission. PARTICIPANTS: Paul Estabrooks continues as the principal investigator for this study and oversees all aspects of the trial. Fabio Almeida continues as a co-investigator and oversees the data collection and management for the trial in addition to the sub-study focusing on social network analysis. Brenda Davy continues as a co-investigator on the study and oversees the dietary component of the intervention and will provide leadership in manuscript production related to beverage consumption. Jennie Hill continues as a co-investigator and oversees the identification of measures of the social and physical environment and will provide leadership for manuscript production related to social capital, social cohesion, and social norms in the context of weight loss. Wen You continues as a co-investigator and oversees the cost data collection and all primary analyses for the study. Sarah Wall is the project coordinator and oversees the graduate research assistants, intervention delivery, and data collection. Jamie Zoellner is a new co-investigator on the project and is responsible for examining the role of health literacy in the weight loss process. Samantha Harden, Serena Parks, Kacie Allen, and Blake Krippendorf have all provided data collection and data entry services as graduate research assistants. Partner Organizations include the National Institute of Diabetes, Digestive and Kidney Diseases who funds the study and the University of North Carolina where Laura Linnan, a co-investigator with worksite weight loss intervention expertise related to process evaluation, is a faculty member. Training or professional development--many of the investigators on the project have used data and funding from this project to present and attend professional development opportunities offered by the American Public Health Association, the Society of Behavioral Medicine, the American Dietetics Association, and the international Society of Behavioral Nutrition and Physical Activity. TARGET AUDIENCES: All overweight and obese employees at participating worksites were eligible to participate. To date 1268 participants from 27 worksites (1 worksite dropped before 6-month completion) have completed the 6-month follow-up visits, 1008 from 25 worksites have completed the 12-month follow-up visits, 820 from 22 worksites have completed the 18-month follow-up visits, and 554 from 16 worksites have completed the 24-month follow-up visits. To date 373 participants have completed the social network analysis survey representing a 70% response rate from the entire employee population in 4 worksites. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

    Impacts
    We are just now beginning to complete our analyses for the two primary aims of the study. The first is to assess the reach of the interventions and the second is to examine effectiveness. This assessemnt will be done in 2021. In addition--in order to address our specific aims during the next year of support, we plan to (a) continue to deliver our intervention to the final 7 sites, (b) continue cost data collections, and (c) continue to collect 6-month, 12-month, 18-month, and 24-month data collections. This current plan will allow us to finalize 24-month assessments for all 28 worksites by the end of Year 5. As such, we have modified our timeline to indicate that 24-month assessments will end on the fourth quarter of Year 5 instead of the second quarter as originally planned. Nonetheless, this will still allow us to meet our original proposed time frame to complete the primary analysis (Effectiveness & Mediation) within the original proposed timeframe (starting on 2nd quarter of Year 5). Research Supplements to Promote Diversity in Health-Related Research Program: 3R01DK071664-04S1 In order to achieve our proposed goals for the research supplement during the next year of support, we plan to (a) continue the weekly mentoring meetings, (b) complete data collection, (c) continue data analysis and manuscript preparation, (d) begin NIH Proposal Preparation and submission.

    Publications

    • Estabrooks PA. (2010). Reach and participation in internet-based worksite weight loss programs. Presented in a symposium at the American Public Health Association. Denver, CO. November 2010.
    • 9You W, Almeida FA, Zoellner JM, Hill JL, Pinard CA, Allen KC, Glasgow RE, Linnan L, Estabrooks PA. (2011) Who Participates in Internet-Based Worksite Weight Loss Programs BMC Public Health, 11:709. http://www.biomedcentral.com/1471-2458/11/709
    • Hedrick VE, Comber DL, Flack KD, Estabrooks PA, Savla J, Davy BM. Development of a brief questionnaire to assess habitual beverage intake: Sugar sweetened beverages and total beverage energy intake. Presented at the American Dietetic Association annual meeting, Boston, MA, November 6-9, 2010.
    • Wall, S.S., Almeida, F.A., Estabrooks, P.A. Worksite physical environmental factors that relate positively to employee physical activity and weight status. Paper presentation at Society of Behavioral Medicine Annual Meeting. April 2011.
    • Zoellner Z, Estabrooks PA, Allen K, Motley M. October 2010. A RE-AIM evaluation of health literacy interventions. Invited presentation at the 2010 Health Literacy Annual Research Conference. Washington, DC. October 2010.
    • Research Supplements to Promote Diversity in Health-Related Research Program: 3R01DK071664-04S1 Almeida, F.A., & Estabrooks P.A. Examining the relationship between social environmental influences and successful weight loss among a sample of overweight and obese employees. Poster accepted for presentation at the 2011 International Society for Behavioral Nutrition and Physical Activity Annual Meeting, June 2011.