Diet and Activity Promotion Among Older Working Adults

DESCRIPTION (provided by applicant): This project will modify an existing emailed program to improve diet and physical activity (PA), by making it more appropriate for workers 55-64 years of age and by adding the ability to deliver automated interactive telephone messages and printed materials tailored to the individual. It will then test the effectiveness and cost-effectiveness of those approaches among workers aged 55-64. Background: Poor diet and physical inactivity are two of the top three causes of chronic diseases and their subsequent medical costs (1). Inexpensive and cost-effective methods are needed to improve these behaviors in this age group, a group with increasing chronic disease and impending Medicare use. The research will build on an existing emailed intervention, ALIVE, which was proven effective in a randomized controlled trial in a worksite (2,3). ALIVE includes a Health Risk Assessment (HRA), tailored feedback, extensive tailoring, weekly goal- setting, interactive features, and health information. Methods: Aims in Phase I are to enhance all components of ALIVE to improve appropriateness for persons 55-64 years, based on focus groups, usability testing, and input from experts in PA ,diet behavior change and aging. Phase I will also demonstrate ability to link ALIVE with new automated telephone and print components. In Phase II, the age-tailored ALIVE will be tested in a randomized controlled trial. Staff and faculty on two campuses of the University of California will be enrolled; those aged 55-64 will be randomized to A) a control group receiving only the HRA and feedback; B) the age-tailored ALIVE program; C) the age-tailored ALIVE program plus phone and print materials. Baseline assessments include diet and PA, and the WHO Health and Work Performance Questionnaire (HPQ). Groups B and C then focus on either increasing PA, increasing fruits and vegetables, or decreasing saturated and trans- fats and added sugars. Over a 4-month period participants will receive tailored email messages and goals, plus phone/print (in group C). At the end of the 4-month period, control and intervention groups will repeat the baseline assessments. Intervention groups will then choose one of the other two goals. This will be repeated again at the end of the second 4-month period, for a total of one year of intervention, with repeat evaluations at the end. Changes in PA, diet, self-reported health and work outcomes will be evaluated using Intention to Treat. Two components of cost effectiveness will be evaluated. First, the effect of observed diet and PA changes on health care costs will be estimated using published external data on the effect of such changes on subsequent risk of chronic disease and cost impacts. Second, improvements in absenteeism and presenteeism as measured by the HPQ will be assessed and monetized based on the HPQ; this will also be expressed as Return on Investment, a metric wanted by employers in decisions about adoption of wellness interventions. The costs and effectiveness of the three treatment arms of the study will be compared. PUBLIC HEALTH RELEVANCE: Almost 45% of Americans have at least one chronic disease, and the medical costs for persons with chronic disease account for almost 75% of health care costs (1). Two of the top three leading causes of death are poor diet and physical inactivity (1). Improvement in these behaviors will result in less morbidity and lower health care costs, and this project will test the effectiveness of a very low-cost proven intervention in a high- risk age group.