This project focuses on the next generation of cancer prevention and control efforts at the worksite. It is the culmination of our programmatic research funded continuously by NCI since 1984, the advances in theory, and the available empirical evidence. The focus is on smaller to moderate-sized worksites that are under-researched, underserved populations of blue collar and less educated workers, and the challenge of improving the public health impact in a cost-effective manner. The next generation of interventions need to be proactive, sustained, and tailored to local needs, multiple risk factor, and integrating individual and environmental change. Ultimately, the intervention must be institutionalized into the fabric of the worksite culture. This research requires scientific rigor, operational practicality and disseminability at reasonable cost. The best efforts to date in worksite health promotion have produced modest impact due to moderate efficacy and reach of interventions. To improve the impact and cost-efficiency, a home-based intervention can enhance and complement a worksite channel. An expert system allows for repeated, proactive, interactive and highly personalized (tailored) interventions that are not always possible at the worksite. This proposal will evaluate the main effects and additive effects of worksite and home-based intervention channels on multiple risk factors for cancer prevention (dietary fat, fiber, smoking, UV exposure, and exercise) in 40 worksites of moderate size recruited from a defined geographic region. The worksites are the unit of assignment and analysis for the worksite versus control evaluation. Individuals are randomly assigned within worksites to home-based or assessment control conditions. Final outcomes are measured at baseline, 12, 24 and 36 months. The worksite intervention is sustained for 24 months, allowing for an evaluation of maintenance and institutionalization at 36 months. Both individual and organizational program, process and intermediate outcome data are collected to shed light on mediating mechanisms (predisposing, enabling and intervening) based on theory-driven models and hypotheses. A sophisticated and field-tested computer tracking system serves to collect program evaluation and cost data on a prospective basis. Path analyses and process-to-outcome analyses will shed light on the mechanisms of action that produce greater versus lesser impact on defined underserved populations of workers. Results will advance the field of worksite cancer control research by evaluating the cost-effectiveness of the next generation of both worksite and home-based interventions.
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