Logo of amjphAmerican Journal of Public Health Web SiteAmerican Public Health Association Web SiteSubmissionsSubscriptionsAbout Us
Am J Public Health. 1998 November; 88(11): 1685–1690.
PMCID: PMC1508574

The effects of a health promotion-health protection intervention on behavior change: the WellWorks Study.


OBJECTIVES: This study assessed the effects of a 2-year integrated health promotion-health protection work-site intervention on changes in dietary habits and cigarette smoking. METHODS: A randomized, controlled intervention study used the work site as the unit of intervention and analysis; it included 24 predominantly manufacturing work sites in Massachusetts (250-2500 workers per site). Behaviors were assessed in self-administered surveys (n = 2386; completion rates = 61% at baseline, 62% at final). Three key intervention elements targeted health behavior change: (1) joint worker-management participation in program planning and implementation, (2) consultation with management on work-site environmental changes, and (3) health education programs. RESULTS: Significant differences between intervention and control work sites included reductions in the percentage of calories consumed as fat (2.3% vs 1.5% kcal) and increases in servings of fruit and vegetables (10% vs 4% increase). The intervention had a significant effect on fiber consumption among skilled and unskilled laborers. No significant effects were observed for smoking cessation. CONCLUSIONS: Although the size of the effects of this intervention are modest, on a populationwide basis effects of this size could have a large impact on cancer-related and coronary heart disease end points.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.7M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Doll R, Peto R. The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst. 1981 Jun;66(6):1191–1308. [PubMed]
  • Willett WC. Vitamin A and lung cancer. Nutr Rev. 1990 May;48(5):201–211. [PubMed]
  • Ziegler RG. Vegetables, fruits, and carotenoids and the risk of cancer. Am J Clin Nutr. 1991 Jan;53(1 Suppl):251S–259S. [PubMed]
  • Steinmetz KA, Potter JD. Vegetables, fruit, and cancer. I. Epidemiology. Cancer Causes Control. 1991 Sep;2(5):325–357. [PubMed]
  • Willett WC. Diet and health: what should we eat? Science. 1994 Apr 22;264(5158):532–537. [PubMed]
  • Glasgow RE, Terborg JR, Hollis JF, Severson HH, Boles SM. Take heart: results from the initial phase of a work-site wellness program. Am J Public Health. 1995 Feb;85(2):209–216. [PMC free article] [PubMed]
  • Heaney CA, Goldenhar LM. Worksite health programs: working together to advance employee health. Health Educ Q. 1996 May;23(2):133–136. [PubMed]
  • Baker E, Israel BA, Schurman S. The integrated model: implications for worksite health promotion and occupational health and safety practice. Health Educ Q. 1996 May;23(2):175–190. [PubMed]
  • Stokols D, Pelletier KR, Fielding JE. The ecology of work and health: research and policy directions for the promotion of employee health. Health Educ Q. 1996 May;23(2):137–158. [PubMed]
  • Covey LS, Zang EA, Wynder EL. Cigarette smoking and occupational status: 1977 to 1990. Am J Public Health. 1992 Sep;82(9):1230–1234. [PMC free article] [PubMed]
  • Sorensen G, Pechacek T. Occupational and sex differences in smoking and smoking cessation. J Occup Med. 1986 May;28(5):360–364. [PubMed]
  • Sterling TD, Weinkam JJ. Smoking patterns by occupation, industry, sex, and race. Arch Environ Health. 1978 Nov-Dec;33(6):313–317. [PubMed]
  • Walsh DC, Jennings SE, Mangione T, Merrigan DM. Health promotion versus health protection? Employees' perceptions and concerns. J Public Health Policy. 1991 Summer;12(2):148–164. [PubMed]
  • Kant AK, Block G, Schatzkin A, Ziegler RG, Nestle M. Dietary diversity in the US population, NHANES II, 1976-1980. J Am Diet Assoc. 1991 Dec;91(12):1526–1531. [PubMed]
  • Patterson TL, Sallis JF, Nader PR, Rupp JW, McKenzie TL, Roppe B, Bartok PW. Direct observation of physical activity and dietary behaviors in a structured environment: effects of a family-based health promotion program. J Behav Med. 1988 Oct;11(5):447–458. [PubMed]
  • Emmons KM, Marcus BH, Linnan L, Rossi JS, Abrams DB. Mechanisms in multiple risk factor interventions: smoking, physical activity, and dietary fat intake among manufacturing workers. Working Well Research Group. Prev Med. 1994 Jul;23(4):481–489. [PubMed]
  • Sorensen G, Stoddard A, Hammond SK, Hebert JR, Avrunin JS, Ockene JK. Double jeopardy: workplace hazards and behavioral risks for craftspersons and laborers. Am J Health Promot. 1996 May-Jun;10(5):355–363. [PubMed]
  • Conrad P. Wellness in the work place: potentials and pitfalls of work-site health promotion. Milbank Q. 1987;65(2):255–275. [PubMed]
  • Glasgow RE, McCaul KD, Fisher KJ. Participation in worksite health promotion: a critique of the literature and recommendations for future practice. Health Educ Q. 1993 Fall;20(3):391–408. [PubMed]
  • Sorensen G, Stoddard A, Ockene JK, Hunt MK, Youngstrom R. Worker participation in an integrated health promotion/health protection program: results from the WellWorks project. Health Educ Q. 1996 May;23(2):191–203. [PubMed]
  • Stunkard AJ, Cohen RY, Felix MR. Weight loss competitions at the worksite: how they work and how well. Prev Med. 1989 Jul;18(4):460–474. [PubMed]
  • Niknian M, Linnan LA, Lasater TM, Carleton RA. Use of population-based data to assess risk factor profiles of blue and white collar workers. J Occup Med. 1991 Jan;33(1):29–36. [PubMed]
  • Baker F. Risk communication about environmental hazards. J Public Health Policy. 1990 Autumn;11(3):341–359. [PubMed]
  • Fischhoff B, Bostrom A, Quadrel MJ. Risk perception and communication. Annu Rev Public Health. 1993;14:183–203. [PubMed]
  • Weinstein ND. The precaution adoption process. Health Psychol. 1988;7(4):355–386. [PubMed]
  • Green KL. Issues of control and responsibility in workers' health. Health Educ Q. 1988 Winter;15(4):473–486. [PubMed]
  • Sorensen G, Himmelstein JS, Hunt MK, Youngstrom R, Hebert JR, Hammond SK, Palombo R, Stoddard A, Ockene JK. A model for worksite cancer prevention: integration of health protection and health promotion in the WellWorks Project. Am J Health Promot. 1995 Sep-Oct;10(1):55–62. [PubMed]
  • Ferrini R, Edelstein S, Barrett-Connor E. The association between health beliefs and health behavior change in older adults. Prev Med. 1994 Jan;23(1):1–5. [PubMed]
  • McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988 Winter;15(4):351–377. [PubMed]
  • Sorensen G, Thompson B, Glanz K, Feng Z, Kinne S, DiClemente C, Emmons K, Heimendinger J, Probart C, Lichtenstein E. Work site-based cancer prevention: primary results from the Working Well Trial. Am J Public Health. 1996 Jul;86(7):939–947. [PMC free article] [PubMed]
  • Glanz K, Patterson RE, Kristal AR, DiClemente CC, Heimendinger J, Linnan L, McLerran DF. Stages of change in adopting healthy diets: fat, fiber, and correlates of nutrient intake. Health Educ Q. 1994 Winter;21(4):499–519. [PubMed]
  • Cohen S, Lichtenstein E, Prochaska JO, Rossi JS, Gritz ER, Carr CR, Orleans CT, Schoenbach VJ, Biener L, Abrams D, et al. Debunking myths about self-quitting. Evidence from 10 prospective studies of persons who attempt to quit smoking by themselves. Am Psychol. 1989 Nov;44(11):1355–1365. [PubMed]
  • Jennrich RI, Schluchter MD. Unbalanced repeated-measures models with structured covariance matrices. Biometrics. 1986 Dec;42(4):805–820. [PubMed]
  • Green LW, Richard L, Potvin L. Ecological foundations of health promotion. Am J Health Promot. 1996 Mar-Apr;10(4):270–281. [PubMed]
  • Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996 Mar-Apr;10(4):282–298. [PubMed]
  • Breslow L. Social ecological strategies for promoting healthy lifestyles. Am J Health Promot. 1996 Mar-Apr;10(4):253–257. [PubMed]
  • Gail MH, Byar DP, Pechacek TF, Corle DK. Aspects of statistical design for the Community Intervention Trial for Smoking Cessation (COMMIT). Control Clin Trials. 1992 Feb;13(1):6–21. [PubMed]
  • Block G, Woods M, Potosky A, Clifford C. Validation of a self-administered diet history questionnaire using multiple diet records. J Clin Epidemiol. 1990;43(12):1327–1335. [PubMed]
  • Sobell J, Block G, Koslowe P, Tobin J, Andres R. Validation of a retrospective questionnaire assessing diet 10-15 years ago. Am J Epidemiol. 1989 Jul;130(1):173–187. [PubMed]
  • Block G, Thompson FE, Hartman AM, Larkin FA, Guire KE. Comparison of two dietary questionnaires validated against multiple dietary records collected during a 1-year period. J Am Diet Assoc. 1992 Jun;92(6):686–693. [PubMed]
  • Coates RJ, Eley JW, Block G, Gunter EW, Sowell AL, Grossman C, Greenberg RS. An evaluation of a food frequency questionnaire for assessing dietary intake of specific carotenoids and vitamin E among low-income black women. Am J Epidemiol. 1991 Sep 15;134(6):658–671. [PubMed]
  • Mares-Perlman JA, Klein BE, Klein R, Ritter LL, Fisher MR, Freudenheim JL. A diet history questionnaire ranks nutrient intakes in middle-aged and older men and women similarly to multiple food records. J Nutr. 1993 Mar;123(3):489–501. [PubMed]
  • Velicer WF, Prochaska JO, Rossi JS, Snow MG. Assessing outcome in smoking cessation studies. Psychol Bull. 1992 Jan;111(1):23–41. [PubMed]
  • Susser M. The tribulations of trials--intervention in communities. Am J Public Health. 1995 Feb;85(2):156–158. [PMC free article] [PubMed]
  • Fisher EB., Jr The results of the COMMIT trial. Community Intervention Trial for Smoking Cessation. Am J Public Health. 1995 Feb;85(2):159–160. [PMC free article] [PubMed]
  • Tosteson AN, Weinstein MC, Hunink MG, Mittleman MA, Williams LW, Goldman PA, Goldman L. Cost-effectiveness of populationwide educational approaches to reduce serum cholesterol levels. Circulation. 1997 Jan 7;95(1):24–30. [PubMed]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...