Cost-Effectiveness and Cost-Benefit of a Lifestyle Intervention for Workers in the Construction Industry at Risk for Cardiovascular Disease Design of a RCT evaluating the (cost-) effectiveness of a lifestyle intervention for male construction workers at risk for cardiovascular disease: The Health under Construction study Short and long term effects of a lifestyle intervention for construction workers at risk for cardiovascular disease: a randomized controlled trial Evaluating clinic and community-based lifestyle interventions for obesity reduction in a low-income Latino neighborhood: Vivamos Activos Fair Oaks Program An Individually Based Lifestyle Intervention for Workers at Risk for Cardiovascular Disease: A Process Evaluation The Lifestyle Intervention for the Treatment of Diabetes study (LIFT Diabetes): Design and baseline characteristics for a randomized translational trial to improve control of cardiovascular disease risk factors. Lifestyle intervention, behavioral changes, and improvement in cardiovascular risk profiles in the California WISEWOMAN project. A community health worker-led lifestyle behavior intervention for Latina (Hispanic) women: feasibility and outcomes of a randomized controlled trial.
Objective : To investigate the cost-effectiveness and cost – benefit of a lifestyle intervention for construction workers with an elevated risk of cardiovascular disease . Methods : In this r and omized controlled trial , usual care was compared to a 6-month individual-based lifestyle intervention . At 6 and 12 months , weight , absenteeism , health care use , and lifestyle-related expenses were determined . Missing data were imputed . A cost-effectiveness analysis was performed from a societal perspective . Uncertainty around the incremental cost-effectiveness ratio ( ICER ) was estimated by bootstrapped cost – effect pairs . A cost – benefit analysis was performed from an employer 's perspective , subtracting the incremental costs from the incremental benefits . Results : The ICER was & OV0556;145/kg weight loss . The difference between intervention and control group in net employer costs was & OV0556;254 ( 95 % CI : −1070 to 1536 ) . Conclusion : Implementation of this important and effective intervention depends on the societal and employer 's willingness to pay Background Of all workers in Dutch construction industry , 20 % has an elevated risk of cardiovascular disease ( CVD ) . A major risk factor for CVD risk is an unhealthy lifestyle . The aim of our study is to design a lifestyle intervention for construction workers with an elevated CVD risk , and to evaluate its ( cost- ) effectiveness . Methods / Design In a RCT , 692 participants will be r and omised to either the control or the intervention group . The control group will receive usual care . For the intervention group , a lifestyle intervention has been design ed based on interviews and current literature . The intervention will last 6 months and will comprise 3 face-to-face and 4 telephone contacts , consisting of individual counselling aim ed at increasing daily physical activity ( PA ) and improving dietary behaviour , and /or smoking cessation . Counselling will take place at the Occupational Health Service ( OHS ) , and will be done according to motivational interviewing ( MI ) . Additional written information about healthy lifestyle will also be provided to those in the intervention group . At baseline , after 6 and after 12 months , measurements will take place . Primary outcome variables will be the lifestyle behaviours of concern , i.e. daily PA , dietary intake , and smoking status . Secondary outcome variables will be body mass index ( BMI ) , systolic and diastolic blood pressure , total and HDL blood cholesterol , Hba1c and cardio-respiratory fitness ( CRF ) . Sickness absenteeism and cost-effectiveness will be assessed as well . Multilevel analysis will be performed to compare all outcome measures between the intervention group and the control group . Discussion By improving lifestyle , CVD risk may be lowered , yielding benefits for both employee and employer . If proven effective , this lifestyle intervention will be implemented on a larger scale within the Occupational Health Services in construction industry . Trial registration Current Controlled Trials IS RCT Background The prevalence of overweight and elevated cardiovascular disease ( CVD ) risk among workers in the construction industry is relatively high . Improving lifestyle lowers CVD risk and may have work-related benefits . The purpose of the study was to evaluate the effects on physical activity ( PA ) , diet , and smoking  of a lifestyle intervention consisting of individual counseling among male workers in the construction industry with an elevated risk of cardiovascular disease ( CVD ) . Methods In a r and omized controlled trial including 816 male blue- and white-collar workers in the construction industry with an elevated risk of CVD , usual care was compared to a 6-month lifestyle intervention . The intervention consisted of individual counseling using motivational interviewing techniques , and was delivered by an occupational physician or occupational nurse . In three face to face and four telephone contacts , the participant 's risk profile , personal determinants , and barriers for behavior change were discussed , and personal goals were set . Participants chose to aim at either  diet and PA  , or smoking . Data were collected at baseline and after six and 12 months , by means of a question naire . To analyse the data , linear and logistic regression analyses were performed . Results The intervention had a statistically significant beneficial effect on snack intake ( β-1.9 , 95%CI -3.7 ; -0.02 ) and fruit intake ( β 1.7 , 95%CI 0.6 ; 2.9 ) at 6 months . The effect on snack intake was sustained until 12 months ; 6 months after the intervention had ended ( β -1.9 , 95%CI -3.6 ; -0.2 ) . The intervention effects on leisure time PA and metabolic equivalent-minutes were not statistically significant . The beneficial effect on smoking was statistically significant at 6 ( OR smoking 0.3 , 95%CI 0.1;0.7 ) , but not at 12 months ( OR 0.8 , 95%CI 0.4 ; 1.6 ) . Conclusions Beneficial effects on smoking , fruit , and snack intake can be achieved by an individual-based lifestyle intervention among male construction workers with an elevated risk of CVD . Future research should be done on strategies to improve leisure time PA and on determinants of maintenance of changed behavior . Considering the rising prevalence of unhealthy lifestyle and CVD , especially in the aging population , implementation of this intervention in the occupational health care setting is recommended . Trial registration Current Controlled Trials IS RCT Background Obesity exerts an enormous health impact through its effect on coronary heart disease and its risk factors . Primary care-based and community-based intensive lifestyle counseling may effectively promote weight loss . There has been limited implementation and evaluation of these strategies , particularly the added benefit of community-based intervention , in low-income Latino population s. Design The Vivamos Activos Fair Oaks project is a r and omized clinical trial design ed to evaluate the clinical and cost-effectiveness of two obesity reduction lifestyle interventions : clinic-based intensive lifestyle counseling , either alone ( n = 80 ) or combined with community health worker support ( n = 80 ) , in comparison to usual primary care ( n = 40 ) . Clinic-based counseling consists of 15 group and four individual lifestyle counseling sessions provided by health educators targeting behavior change in physical activity and dietary practice s. Community health worker support includes seven home visits aim ed at practical implementation of weight loss strategies within the person 's home and neighborhood . The interventions use a framework based on Social Cognitive Theory , the Transtheoretical Model of behavior change , and techniques from previously tested lifestyle interventions . Application of the framework was culturally tailored based on past interventions in the same community and elsewhere , as well as a community needs and assets assessment . The interventions include a 12-month intensive phase followed by a 12-month maintenance phase . Participants are obese Spanish-speaking adults with at least one cardiovascular risk factor recruited from a community health center in a low-income neighborhood of San Mateo County , California . Follow-up assessment s occur at 6 , 12 , and 24 months for the primary outcome of percent change in body mass index at 24 months . Secondary outcomes include specific cardiovascular risk factors , particularly blood pressure and fasting glucose levels . Discussion and Conclusions If successful , this study will provide evidence for broad implementation of obesity interventions in minority population s and guidance about the selection of strategies involving clinic-based case management and community-based community health worker support . Clinical Trial Registration Clinical Trials.gov : Purpose . Evaluate counselors ' adherence to an intervention protocol , counselors ' competence , and the associations between three process indicators and body weight at follow-up in a 6-month individually based lifestyle intervention for construction workers . Design . Process evaluation with qualitative and quantitative data . Setting . Occupational health service . Subjects . A total of 408 male construction workers with an elevated risk of cardiovascular disease received the intervention , and 27 occupational health professionals delivered the intervention . Intervention . Seven counseling sessions , the first during which four prescribed items had to be discussed .  Motivational interviewing ( MI ) was used as a counseling technique . Measures and Analysis . The number of sessions and the items discussed were registered by the counselors . Adherence to MI  was determined by expert scoring of transcripts of r and om segments of 19 counseling sessions . Counselors ' competence was rated by participants and counselors separately . Associations between three process indicators and body weight at follow-up were determined by linear and logistic regression analyses . Results . Two-thirds of all participants attended five or more sessions , and 38.5 % attended all seven sessions . In 90.2 % of all cases , the counselor discussed all obligatory items in the first session . MI adherence was reached in one audiotaped fragment . Most ( 86.3 % ) of all participants agreed with the counselor being competent . Neither counselors ' competence nor number of sessions or items discussed was significantly associated with body weight loss . Conclusions . Performing five sessions and discussing four prescribed items was feasible for the counselors , whereas performing MI was not . Still , participants were positive about the counselors ' competence and willing to attend the intervention sessions . Investigators are encouraged to report the evaluation of their intervention process to improve future lifestyle interventions in research or in practice The prevalence of type 2 diabetes continues to increase in minority and underserved patients , who are also more likely to have poorer control of diabetes and related risk factors for complications . Although the Look AHEAD trial has demonstrated improved risk factor control among overweight or obese diabetes patients who received an intensive lifestyle intervention  , translating such findings into accessible programs is a major public health challenge . The purpose of this paper is to report the design and baseline characteristics of the Lifestyle Interventions for the Treatment of Diabetes study ( LIFT Diabetes ) . The overall goal is to test the impact of a community-based lifestyle weight loss ( LWL ) intervention adapted from Look AHEAD on cardiovascular disease risk at 12-months and 24-months among minority and lower income diabetes patients . Secondary outcomes include body weight , physical activity , medication use , cost , re source utilization , and safety . The primary hypothesis being tested is that the  LWL  will result in 10 % relative reduction in CVD risk compared to the DSM . We have r and omized 260 overweight or obese adults with diabetes one of two 12-month interventions : a LWL condition delivered by community health workers or a diabetes self-management ( DSM ) education condition . The baseline demographic characteristics indicate that our sample is predominantly female , obese , low income , and ethnic minority . Translating evidence -based , lifestyle strategies , and targeting minority and underserved patients , will yield , if successful , a model for addressing the burden of diabetes and may favorably impact health disparities BACKGROUND The Well-Integrated Screening and Evaluation for Women Across the Nation ( WISEWOMAN ) program in California ( Heart of the Family ) implements lifestyle interventions to improve health behaviors while reducing cardiovascular disease ( CVD ) risk factors among low income , uninsured , or underinsured Hispanic women aged 40 - 64 who participate in the Cancer Detection Programs : Every Woman Counts ( CDP : EWC ) . This study reports the first-year results of the California WISEWOMAN program . METHODS Heart of the Family is a within-site r and omized controlled study with an enhanced intervention group ( EIG ) and a usual care group ( UCG ) . The study was conducted between January 2006 and June 2007 at four community health centers in Los Angeles and San Diego counties .  Lifestyle counseling focusing on health behaviors was provided by bilingual , bicultural ( Spanish and English ) community health workers . The study examines two outcome measures : changes in health behaviors ; and changes in the CVD risk profile , as measured by the 10-year probability of having a coronary heart disease ( CHD ) event . RESULTS Women in the EIG group ( n = 433 ) , compared to those in the UCG group ( n = 436 ) , experienced more improvements in health behaviors , both eating habits and physical activity . The improvement in the 10-year CHD risk was greater for EIG than UCG women . Multiple regression results indicate that this improvement was significantly greater when the women 's CHD risk levels were in the upper quartile at baseline . CONCLUSIONS Compared with UCG women , women in the EIG were more likely to improve their health behaviors . The CVD risk profile , as measured by the 10-year CHD risk , improved in women with the highest baseline risk BACKGROUND Low-income Latinas ( Hispanics ) face risk for cardiovascular disease due to high rates of overweight/obesity , sedentary lifestyle , and other factors . Limited access to health care and language barriers may prevent delivery of health promotion messages . Targeted approaches , including the integration of community health workers , may be required to promote healthy lifestyle and prevent chronic disease in underserved ethnic minority groups . The term commonly used to refer to female community health workers in Latino communities is " promotora(s ) . " OBJECTIVES This study evaluates the outcomes and feasibility of a promotora-led lifestyle behavior intervention for overweight , immigrant Latinas . METHODS A community prevention model was employed in planning and implementing this study . A r and omized controlled trial design was used . A Community Advisory Board provided expertise in evaluating feasibility of study implementation in the community and other important guidance . The sample was comprised of 223 women aged 35 - 64 years , predominantly with low income and ≤8th grade education . The culturally tailored Lifestyle Behavior Intervention included group education ( 8 classes based upon Su Corazon , Su Vida ) , followed by 4 months of individual teaching and coaching ( home visits and telephone calls ) . The control group received a comparable length educational program and follow-up contacts . Evaluations were conducted at baseline and at 6 and 9 months using a dietary habits question naire , accelerometer readings of physical activity , and clinical measures ( body mass index , weight , waist circumference , blood pressure , lipids , blood glucose ) . Data were collected between January 2010 and August 2012 . RESULTS Women in the intervention group improved significantly in dietary habits , waist circumference , and physical activity in comparison to those in the control group . A treatment dosage effect was observed for weight and waist circumference . Knowledge about heart disease increased . High attendance at classes and participation in the individual teaching and counseling sessions and high retention rates support the feasibility and acceptability of the promotora-led lifestyle behavior intervention . CONCLUSIONS Our findings demonstrate that lifestyle behaviors and other risk factors of overweight Latina women may be improved through a promotora-led lifestyle behavior intervention . Feasibility of implementing this intervention in community setting s and engaging promotoras as facilitators is supported
There was no statistically significant publication bias , except for systolic blood pressure .
This study examined the effect of lifestyle interventions on  cardiovascular disease risk factors among workers .