The purposes of the current proposal are: 1. to study the relative effectiveness of teaching occupational nurses to conduct cholesterol screening, counseling and referral events (SCOREs) in their own worksites versus using an external organization to implement these programs; and 2. to study the relative effectiveness of face-to-face behavior change counseling following the cholesterol measurement versus automated feedback of essentially the same individualized educational material. The research design is a 2 x 2 design with repeated measures at 6 and 12 months after the Baseline measurement and treatment application. The current study proposes to test the relative effectiveness of two major dimensions of blood cholesterol change programming in worksites of 250 - 800 employees with at least one occupational nurse. The overall design in 2 x 2 with 10 of 25 worksites randomly assigned to an internal Condition and 10 worksites assigned to an External Condition. In the Internal Condition, occupational nurses will be trained by project staff to implement the SCOREs and will be given Reflotron portable dry chemistry analyzers to measure cholesterol. In the External Condition, the SCORE will be conducted by an external organization (project staff). Five (5) worksites from each of the above conditions will have the educational session of the SCORE delivered face-to-face [Face-to-Face condition (FF)] by either the nurse or project staff, depending on the condition (Internal + FF or External + FF). The other 10 worksites will have this education delivered by a microcomputer/optical scanner (the RT 2000) that reads the participant's risk factor and self-reported eating pattern information and delivers a print-out with recommendations that are prioritized and individualized for the participant (RT intervention will be delivered by the nurse or project staff depending on the condition (Internal + RT or External + RT). All SCORE participants in the above 20 worksites will also receive a self-help nutrition change kit. This cross design allows testing for possible interaction effects. Another group of 5 worksites is also included which will serve as a comparison group for the External Condition. The employees in this group will receive a screening and education experience similar to the usual type of program offered by external, commercial screeners with minimal written education materials and no individualized feedback (Usual Care External Condition). The primary dependent variables include measured blood cholesterol, weight, other CHD risk factors, and self-reported eating pattern. Change will be assessed 6 and 12 months after the SCOREs are conducted. A wide range of other variables including process, cost and mediating variables will be assessed through the project period.
