Journal of Occupational and Environmental Medicine. 2007; 49:204-213 1 Parisa Amiri Health Education...

Journal of Occupational and Environmental Medicine.

2007; 49:204-213

1Parisa Amiri

Health Education Department

Among the US population physical inactivity and unhealthy nutrition habits are underlying factors for an estimated 300 000 death each

year.

For the 7 million Americans with known coronary heart disease, lack of regular

exercise is the most prevalent cardiac risk factor.

2Parisa Amiri


Among American Adults :

60 million with hypertension

70 million with obesity

13 million with type 2 diabetes 52 million with high cholesterol

3Parisa Amiri


Even a modest increase in physical activity may significantly lower the risk of coronary heart disease.

One-third of both coronary disease and cancer could be prevented with healthy eating habits.

Regular exercise and the recommended nutrition practices may be synergistic in promoting health.

4Parisa Amiri


Evidence for the benefits of regular physical activity and a healthy diet is overwhelming, yet the majority

of Americans do neither.

5Parisa Amiri


The PHLAME Study ( Promoting Healthy Lifestyles: Alternative Model’s Effects) is one of 15 projects funded by the National Institute of Health as the Behavior Change Consortium(BCC) to assess new means to promote healthy eating habits (five or more servings of fruits and vegetables each day and less than 30% of calories from fat), regular physical activity and appropriate body weight.

6Parisa Amiri


PopulationFire fighters

Requiring vigorous physical activity while being exposed to extreme heat and the stress of urgent life-threatening situation

Fire fighters must perform physically intense work under conditions which increase myocardial oxygen demand, such as high temperatures and carbon monoxide inhalation.

7Parisa Amiri


Studies indicate a high prevalence of sedentary lifestyles, obesity, hypertension, dyslipidemis, and chronic musculoskeletal disorders among fire fighters.

Cardiovascular disease is a significant problem for fire fighters.

Fire fighters ‘ work structure is well suited for a team-centered intervention.

8Parisa Amiri


Purpose Implement and prospectively assess two

health promotion behavior change interventions each based on a different theoretical model for promoting healthy nutrition practices and regular physical activity.

Compare these two change models together and against a usual-care control group to provide an understanding of how, under what condition and at what expense change can occur and maintained.

9Parisa Amiri


Study groups & Theoretical rationales

One-on-one intervention, TTM, Motivational interviewing

Team-centered intervention, SCT, Peer-led

Control

10Parisa Amiri


Hypothesis

Both a team centered curriculum and individual counseling would result in healthier lifestyles than the control condition

Team format would be as efficacious as MI.

11Parisa Amiri


Target behaviorsSuccess Criteria

30 min of physical activity per day

Percent total calories from dietary fat of less than 30%

At least five servings of fruits and vegetables per day

Ideal body fat percentages

12Parisa Amiri


Primary outcome measures

Nutrition and eating habits( % calories as fat, daily servings of fruits and vegetables; dietary behavior)

Cardio respiratory fitness ( measured maximum oxygen uptake, strength measures and flexibility assessments)

Self-reported physical activity, flexibility, sit-and-reach test, and hand grip and quadriceps strength

Percent body fat by skin-fold measures, waist/ hip ratio, height, weight and BMI

13Parisa Amiri


Secondary outcomes

Resting blood pressure LDL- Cholesterol, HDL- Cholesterol and triglycerides Quality of life index Fasting serum glucose level Incidence of back and other musculoskeletal injuries Hand grip and quadriceps strength Back flexibility

14Parisa Amiri


MeasuresTo standardize data collection, individuals were evaluated at

approximately 8:00 AM

Demographic KAP

Quality of life

Dietary habits(daily servings of fruits and vegetables and percentage of total calories from fat)

Physiological measures

15Parisa Amiri


Parisa Amiri Health Education Department 16

One-on-one counseling formatUsing

TTM & Motivational interviewing

17

Client-centeredEmphasizes reflective listeningClarifying problemsDelineating personal motivation for changePresenting optionsAdvocating relevant benefits of changeSupporting the client’s self-efficacy for change

Individualize

The

interaction

to a subject’s

stage of

change

Three to four sessions (60 min) & phone follow-up (18) & 4.5 hours additional contact ( 8.25 h)

First session Phlame study Participant’s health concerns Values card sort(firefighter prioritize) Discuss about the relation between values

healthy life style Second and third sessions Test’s results using client-centered counseling techniques to provide support and motivation for behavior change

18Parisa Amiri


Team-centered interventionTeam: Peer bonds, mutual accountability, shared responsibilities

or rewards

Each shift became a team

Team leader ( Team leader manual) & 60 min orientation to the curriculum’s format

Firefighters’ Health & Fitness Guide ( 160 page booklet)

educational sessions (11 45)

Manual & work books

19Parisa Amiri


Pilot studyA six month pilot study of the three conditions

was conducted with three fire stations. The pilot study was used to refine the intervention protocols, assessment instruments and testing

procedures for the full study.

Poster presented at the meeting of

the sixth international congress of behavioral medicine, Australia, 2000.

20Parisa Amiri


21

Not meeting inclusion criteria n=17

Refused to participate n=80

Enrollment

Randomized n=599(86%)

Assessed for eligibility n=696

Allocation and initial training

Team curriculum

n=234(39%)

Motivational intervention(

MI)n=202(34%)

Controln=163(27%)

Intervention and follow-up

Received intervention

n=188(79%)


n=168(83%)


n=135(83%)

Repeat testing at one year and analysis

Analyzed n=186(79%)

Analyzed n=185(82%)

Excluded due to transferred to team

shift n=3

Analyzed n=129(79%)

Excluded due to transfer to team shift

n=6

Results

22Parisa Amiri


Team curriculum

Individual motivational interviewing

Control Total

Age* 39 ± 9 42 ± 9 41 ± 9 41 ± 9

Years as firefighter

15 ± 9 17 ± 8 16 ± 9 16 ± 9

Runs per shift**

3.5 ± 1.1 4.0 ± 1.6 3.4 ± 1.2 3.7 ± 1.3

Male 96% 97% 98% 97%

White 92% 88% 92% 91%

Married 79% 79% 79% 79%

23Parisa Amiri


Average runs/shift recorded ranges: 1=0(not station based); 2= 1-2; 3= 3-5; 4= 6-8; 5=9-12; 6>12.*P< 0.01.* * P<0.0001.

Firefighter characteristics at baseline (mean ± SD)

24

Team curriculum

Individual counseling

Control

Baseline One year

Baseline One year

Baseline One year

Daily servings fruits vegetables

5.8(0.2)

7.4**(0.3)

5.5(0.3)

6.2*(0.3)

5.7(0.3)

5.8(0.3)

Percent calories from fat 34.1(0.5)

31.9(0.4)

34.9(0.4)

32.5(0.4)

35.6(0.5)

35.6(0.4)

Healthy dietary behavior 4.41(0.07)

4.55 †(0. 07)

3.96(0.06)

4.43 †(0.08)

3.99(0.09)

4.12(0.09)

Dietary understanding 5.53(0.07)

5.84 †(0.07)

5.56(0.07)

5.63(0.08)

5.57(0.09)

5.55(0.09)

Positive dietary social support

3.24(0.06)

3.60 ‡(0.06)

3.41(0.06)

3.15(0.06)

3.22(0.08)

2.68(0.07)

Peak oxygen uptake (ml/kg/min)

39.6(0.1)

41.3(0.1)

39.5(0.1)

40.9(0.06)

38.3(0.6)

39.1(0.1)

Sit-up in 1 min 36.3(0.6)

38.4*(0.6)

34.5(0.5)

37.4*(0.08)

35.1(0.6)

36.0(0.8)

*P< 0.05, **P<0.01, †P<0.005, ‡ P<0.001

25

Healthy physical activity behavior

3.38(1.44)

3.61(1.37)

3.07(1.40)

3.32(1.02)

3.19(1.40)

3.28(1.45)

Physical activity beliefs and understanding

6.19(0.06)

6.25(0.07)

6.00(0.07)

6.06(0.06)

6.10(0.07)

6.08(0.07)

Positive physical activity social support

3.43(0.07)

3.48 *(0.07)

3.41(0.08)

3.48(0.08)

3.11(0.08)

3.15(0.07)

Body weight(lbs) 195.7(2.2)

196.6 *(2.2)

192.7(2.1)

193.9*(2.1)

196(2.6)

200(2.8)

Body mass index 27.4(0.3)

27.5 *(0.3)

27.1(0.3)

27.3*(0.3)

27.9(0.3)

28.4(0.4)

Overall well-being 3.59(0.06)

3.70 *(0.06)

3.65(0.06)

3.73*(0.05)

3.57(0.06)

3.51(0.08)

Team curriculum

Individual counseling

Control

Baseline One year

Baseline One year

Baseline One year

*P< 0.05, **P<0.01, †P<0.005, ‡ P<0.001

Baseline cross-sectional model

Parisa Amiri Health Education Department 27

Intervention Model

28

Simple model

Model with intervention

One-year

Baseline One-year

χ2 17.94 14.37 17.24

Degrees of freedom (df)

8 8 12

Χ2/df 2.24 1.79 1.44

CFI 0.960 0.978 0.989

RMSEA 0.055 0.043 0.032

SRMR 0.039 0.029 0.025

Model fit is acceptable when : χ2 / df <3, CFI> 0.95, RMSEA < 0.06, SRMR<0.05

Conclusion

29Parisa Amiri


Both a team-centered and individual-oriented intervention promoted healthy behaviors.

The scripted team curriculum is innovative, exportable, and may enlist influences not accessed with individual formats.

30Parisa Amiri


Journal of Occupational and Environmental Medicine. 2007; 49:204-213 1 Parisa Amiri Health Education...

Documents

Transcript of Journal of Occupational and Environmental Medicine. 2007; 49:204-213 1 Parisa Amiri Health Education...