ABSTRACT
BACKGROUND: U.S. adults are at unprecedented risk of becoming overweight or obese, and most scientists believe the primary cause is an obesogenic environment. Worksites provide an opportunity to shape the environments of adults to reduce obesity risk. The goal of this group-randomized trial was to implement a four-component environmental intervention at the worksite level to positively influence weight gain among employees over a two-year period. Environmental components focused on food availability and price, physical activity promotion, scale access, and media enhancements. METHODS: Six worksites in a U.S. metropolitan area were recruited and randomized in pairs at the worksite level to either a two-year intervention or a no-contact control. Evaluations at baseline and two years included: 1) measured height and weight; 2) online surveys of individual dietary intake and physical activity behaviors; and 3) detailed worksite environment assessment. RESULTS: Mean participant age was 42.9 years (range 18-75), 62.6% were women, 68.5% were married or cohabiting, 88.6% were white, 2.1% Hispanic. Mean baseline BMI was 28.5 kg/m(2) (range 16.9-61.2 kg/m(2)). A majority of intervention components were successfully implemented. However, there were no differences between sites in the key outcome of weight change over the two-year study period (p = .36). CONCLUSIONS: Body mass was not significantly affected by environmental changes implemented for the trial. Results raise questions about whether environmental change at worksites is sufficient for population weight gain prevention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00708461.
Subject(s)
Diet , Exercise , Health Behavior , Health Promotion/methods , Obesity/prevention & control , Occupational Health , Weight Gain , Adolescent , Adult , Aged , Body Mass Index , Commerce , Diet/economics , Environment , Female , Food Supply , Humans , Male , Middle Aged , Obesity/etiology , Obesity/therapy , United States , Urban Population , Workplace , Young AdultABSTRACT
OBJECTIVE: The primary objective of this study was to develop and test a highly interactive Internet-based HIV prevention intervention for men who have sex with men (MSM). MSM remain the group at highest risk for HIV/AIDS in the United States and similar countries. As the Internet becomes popular for seeking sex, online interventions to reduce sexual risk are critical. Given previous studies, a secondary objective was to demonstrate that good retention is possible in online trials. DESIGN: A randomized controlled trial with 3-month, 6-month, 9-month, and 12-month follow-up design was employed. METHODS: In 2008, 650 participants were randomized to an online, interactive sexual risk reduction intervention or to a waitlist null control. RESULTS: Retention was 76-89% over 12 months. At 3-month follow-up, results showed a 16% reduction in reported unprotected anal intercourse risk among those in the treatment condition versus control [95% confidence interval (95% CI) of rate ratio: 0.70-1.01]. No meaningful differences were observed at 12-month follow-up. CONCLUSION: Internet-based, persuasive computing programs hold promise as an effective new approach to HIV prevention for MSM, at least in the short term. Further, online trials can be conducted with acceptable retention provided strong retention protocols are employed. Four directions for future research are identified.
