Sonia Bishop

Perceived stress, behavior, and body mass index among adults participating in a worksite obesity prevention program, Seattle, 2005-2007.

Introduction Stress in numerous contexts may affect the risk for obesity through biobehavioral processes. Acute stress has been associated with diet and physical activity in some studies; the relationship between everyday stress and such behavior is not clear. The objective of this study was to examine associations between perceived stress, dietary behavior, physical activity, eating awareness, self-efficacy, and body mass index (BMI) among healthy working adults. Secondary objectives were to explore whether eating awareness modified the relationship between perceived stress and dietary behavior and perceived stress and BMI. Methods Promoting Activity and Changes in Eating (PACE) was a group-randomized worksite intervention to prevent weight gain in the Seattle metropolitan area from 2005 through 2007. A subset of 621 participants at 33 worksites provided complete information on perceived stress at baseline. Linear mixed models evaluated cross-sectional associations. Results The mean (standard deviation [SD]) Perceived Stress Scale-10 score among all participants was 12.7 (6.4), and the mean (SD) BMI was 29.2 kg/m2 (6.3 kg/m2). Higher levels of perceived stress were associated with lower levels of eating awareness, physical activity, and walking. Among participants who had low levels of eating awareness, higher levels of perceived stress were associated with fewer servings of fruit and vegetables and greater consumption of fast food meals. Conclusion Dietary and physical activity behaviors of workers may be associated with average levels of perceived stress. Longitudinal studies are needed, however, to support inclusion of stress management or mindfulness techniques in workplace obesity prevention efforts.

The association between worksite social support, diet, physical activity and body mass index

OBJECTIVE Social support may be associated with improved diet and physical activity-determinants of overweight and obesity. Wellness programs increasingly target worksites. The aim was to evaluate the relationship between worksite social support and dietary behaviors, physical activity, and body mass index (BMI). METHOD Baseline data were obtained on 2878 employees from 2005 to 2007 from 34 worksites through Promoting Activity and Changes in Eating, a group-randomized weight reduction intervention in Greater Seattle. Worksite social support, diet, physical activity, and BMI were assessed via self-reported questionnaire. Principal component analysis was applied to workgroup questions. To adjust for design effects, random effects models were employed. RESULTS No associations were found with worksite social support and BMI, or with many obesogenic behaviors. However, individuals with higher worksite social support had 14.3% higher (95% CI: 5.6%-23.7%) mean physical activity score and 4% higher (95% CI: 1%-7%) mean fruit and vegetable intake compared to individuals with one-unit lower support. CONCLUSION Our findings do not support a conclusive relationship between higher worksite social support and obesogenic behaviors, with the exception of physical activity and fruit and vegetable intake. Future studies are needed to confirm these relationships and evaluate how worksite social support impacts trial outcomes.

Worksite Study Promoting Activity and Changes in Eating (PACE) : Design and Baseline Results

Objective: Based on previous worksite‐wide intervention studies and an ecological framework, we created a behavioral intervention program to maintain or reduce weight through healthy eating and physical activity. The design and evaluation plan of the group‐randomized trial and the recruitment of worksites are described. Preliminary results regarding the dietary and physical activity behaviors associated with BMI are discussed.

Long-term fruit and vegetable change in worksites: Seattle 5 a Day follow-up.

OBJECTIVE To evaluate long-term change in fruit and vegetable intake following a group randomized trial of worksites. METHODS Medium-sized blue-collar businesses in the Seattle metropolitan area were recruited. Intake was assessed using serial cross-sectional samples of current workforce at 3 time points. The multilevel 18-month intervention involved partnership with the companies. Long-term follow-up was at 4.4 years postbaseline. Statistical analysis used general linear models, adjusting for worksite random effects. RESULTS Initially, 45 worksites were randomized, with 29 agreeing to participate in a new study. Fruits and vegetable intake increased, with larger sustained changes in the intervention worksites, resulting in a long-term differential change of 0.25 servings per day, 95% confidence interval (0.09 to 0.40). CONCLUSIONS Intervention sustained small effects at 4 years, including 2 years with no contact. Although effects were not large, this low-intensity intervention approach could provide an important public health model.

Environmental assessment at worksites after a multilevel intervention to promote activity and changes in eating: the PACE project.

Objective: To evaluate changes in the worksite environment in response to a multilevel intervention over a 2-year period. Methods: Worksites were recruited in the greater Seattle area, and 34 were randomized to intervention or comparison condition. The intervention was based on the ecological model, with a framework of defined phases of intervention that included worksite-wide events implemented in partnership with employee-based advisory boards. The assessment of the worksite environment used a modification of the Checklist of Health Promotion Environments at Worksites. Subscales were developed using baseline data only. The intervention effect on different aspects of the worksite environment was estimated using logistic regression with robust estimating procedures. Results: Only changes in the physical activity and nutrition information environments were significantly associated with the intervention. Conclusions: This article provides one of the first attempts at using environmental assessment in the evaluation of worksite interventions.

Factors related to participatory employee advisory boards in small, blue-collar worksites

Purpose. To identify factors related to formation, participation, and characteristics of employee advisory boards (EABs) in blue-collar worksites. Design. This study used a nonexperimental qualitative design to assess EAB formation, activity, and enthusiasm levels and examined those factors relative to employee participation in worksite-wide health promotion activities. Setting. Twenty-two blue-collar worksites with a total of 113 EAB members in the greater Seattle area. Subjects. Individuals who agreed to serve on EABs in the intervention worksites. Intervention. Participants received training in involving employees in the 5-A-Day project intervention activities. Measures. Measures include type of worksite, number of EAB members, method of EAB recruitment, and variables describing EAB functioning, including attendance at meetings, assistance at project activities, and level of enthusiasm. Results. All worksites formed EABs. There was no association between the way the EAB was formed and subsequent EAB attendance at meetings, participation in project activities, representativeness of the EAB, or level of EAB enthusiasm. Enthusiasm of the EAB was associated with employee participation, and EABs with a higher level of enthusiasm showed more participation by employees than worksites with less enthusiastic EABs. Conclusions. It is possible to develop participatory structures in small, blue-collar worksites. More information is needed about factors related to levels of enthusiasm of EABs.

Family/friend recommendations and mammography intentions: the roles of perceived mammography norms and support

Identifying factors that increase mammography use among Latinas is an important public health priority. Latinas are more likely to report mammography intentions and use, if a family member or friend recommends that they get a mammogram. Little is known about the mechanisms underlying the relationship between social interactions and mammography intentions. Theory suggests that family/friend recommendations increase perceived mammography norms (others believe a woman should obtain a mammogram) and support (others will help her obtain a mammogram), which in turn increase mammography intentions and use. We tested these hypotheses with data from the ¡Fortaleza Latina! study, a randomized controlled trial including 539 Latinas in Washington State. Women whose family/friend recommended they get a mammogram within the last year were more likely to report mammography intentions, norms and support. Perceived mammography norms mediated the relationship between family/friend recommendations and intentions, Mediated Effect = 0.38, 95%CI [0.20, 0.61], but not support, Mediated Effect = 0.002, 95%CI [-0.07, 0.07]. Our findings suggest perceived mammography norms are a potential mechanism underlying the effect of family/friend recommendations on mammography use among Latinas. Our findings make an important contribution to theory about the associations of social interactions, perceptions and health behaviors.

Gardening for Health: Patterns of Gardening and Fruit and Vegetable Consumption Among the Navajo

American Indians, including Navajo, are disproportionately affected by obesity and diabetes, in part due to diet-related health behaviors. The purpose of this study was to assess the patterns of gardening and fruit and vegetable (FV) consumption among residents in two communities on the Navajo Nation in order to inform a community gardening intervention. We analyzed survey data collected from participants in the Yéego Gardening study conducted in two communities in the Navajo Nation (N = 169). We found that 51% of the sample gardened, and on average participants gardened 8.9 times per month. Lack of time (53%) and financial barriers, such as gas for transportation or irrigation (51 and 49%, respectively), were reported as barriers to gardening. Most participants reported low levels of self-efficacy (80%) and behavioral capability (82%) related to gardening. Those with higher levels of gardening self-efficacy and behavioral capability reported more frequent gardening. Average daily FV consumption was 2.5 servings. Most participants reported high levels of self-efficacy to eat FV daily (64%) and high behavioral capability to prepare FV (66%). There was a positive association between FV consumption and gardening, with those gardening more than 4 times per month eating about 1 more serving of FV per day than those gardening 4 or fewer times per month. Further research is needed to better understand how gardening can increase fruit and vegetable availability and consumption among residents of the Navajo Nation.

Yéego Gardening! A Community Garden Intervention to Promote Health on the Navajo Nation

Abstract:Background: Yéego Gardening! is a community garden intervention to increase gardening behavior, increase access to low-cost fruit and vegetables, and ultimately increase consumption in Navajo communities.Objectives: To design a theory-based, culturally relevant intervention with three components: a community garden, monthly workshops on gardening and healthy eating, and community outreach.Methods: Gardens were constructed and maintained in collaboration with community-based organizations in two Navajo communities. Monthly workshops were held throughout the growing season and incorporated aspects of Navajo culture and opportunities to build confidence and skills in gardening and healthy eating behaviors. In addition, program staff attended community events to promote gardening and healthy eating.Conclusions: Community input was essential throughout the planning and implementation of the intervention. If effective, community gardens may be a way to increase fruit and vegetable availability and intake, and ultimately reduce risk of obesity and diabetes.

Abstract SS01-05: Multilevel breast cancer intervention in Latinas.

Introduction: Hispanics are the fastest growing population in the United States (US). They present a mixed picture of cancer incidence and mortality. For breast cancer, Latinas have a lower incidence (83.5 per 100,000) than non-Hispanic White (NHW) women (147.3 per 100,000); however, with longer time in the US, breast cancer incidence increases in Latinas. Further, they are more likely to be diagnosed in late stage and therefore have lower five year survival rates than NHW women. Finally, Latinas are more likely to suffer from triple negative cancers that are more aggressive than estrogen-receptive cancer. One reason for the late-stage diagnosis may be that Latinas, especially Mexican-American women, are less likely to present for mammography screening than NHW women. In a recent study by Miranda et al., evidence shows that for Mexican-American women overall, less than 60 percent have had a mammogram. Furthermore, the lack of a medical home means that many Latinas do not routinely receive messages about the importance of mammography nor are they likely to receive referrals for mammography. In our P-50 funded by the National Cancer Institute9s Center for Population Health and Health Disparities (CPHHD), we have a multi-level mammography promotion project. Called Fortaleza Latina, the overall goal of the project is to develop and test a culturally-appropriate multi-level intervention aimed at increasing screening mammography utilization in a clinic-based sample of Latino women in Western Washington State. Of corollary interest is the way Latinas perceive their risk of getting breast cancer and their response to perceived risk. For this study, we are especially interested in perceptions of risk and decisions Latinas report they would make based on their perceptions. Methods: In a two-armed study (control vs. intervention), Latinas who are out of compliance with mammography are identified by a federally qualified health clinic system. After a baseline survey is conducted, women are randomized to receive the intervention vs. usual care. The baseline survey contains a number of questions that are related to breast cancer risk perception by Latinas. Three questions that assess perceived risk refer to one9s own risk of developing breast cancer, one9s risk compared to other women, and one9s worry about developing breast cancer. Variables that were examined as correlates of risk include the presence of a medical home, the presence of health insurance, the financial ability to pay, attitudes about recommendations for mammography, and demographic variables. Results: Of 358 women who were out of compliance with mammography and who responded to the baseline questionnaire to date, 94 percent were of Hispanic origin. Of these, 91 percent speak Spanish most of the time and 97 percent were born outside of the US with over 80 percent born in Mexico. In terms of perceived risk of developing breast cancer, 41 percent perceived their risk as low, 41 percent as moderate, and 18 percent as high. Perceived risk compared to others was more likely (10%), about the same (57%), and less likely (33%). In terms of worry, 31 percent said rarely, 51 percent said sometimes, and 17 percent said frequently. There were no relationships between medical home and perceived risk or health insurance and perceived risk, although over 53 percent of respondents said cost would be an issue. Discussion: Perceived risk of breast cancer in this population is relatively low, with 1 in 5 women perceiving their risk as high. Many variables that were thought to correlate with risk did not do so, suggesting that commonly thought variables of association were not supported. Although this was a multi-level study looking at neighborhood, clinic, and individual, variation in the population was small with 49 percent of respondents having a household income of