OBJECTIVES. This paper presents the behavioral results of the Working Well Trial, the largest US work site cancer prevention and control trial to date. METHODS. The Working Well Trial used a randomized, matched-pair evaluation design, with the work site as the unit of assignment and analysis. The study was conducted in 111 work sites (n = 28,000 workers). The effects of the intervention were evaluated by comparing changes in intervention and control work sites, as measured in cross-sectional surveys at baseline and follow-up. The 2-year intervention targeted both individuals and the work-site environment. RESULTS. There occurred a net reduction in the percentage of energy obtained from fat consumption of 0.37 percentage points (P = .033), a net increase in fiber densities of 0.13 g/1000 kcal (P = .056), and an average increase in fruit and vegetable intake of 0.18 servings per day (P = .0001). Changes in tobacco use were in the desired direction but were not significant. CONCLUSIONS. Significant but small differences were observed for nutrition. Positive trends, but no significant results, were observed in trial-wide smoking outcomes. The observed net differences were small owing to the substantial secular changes in target behaviors.
The Community Intervention Trial for Smoking Cessation (COMMIT) has adopted a community approach to smoking cessation. State-of-the-art interventions that have proven efficacious for smoking cessation are delivered to smokers through community-based organizations. An innovative adaptation of community organization methods accommodated the need for a standardized protocol with the flexibility required for diverse and unique communities. The unique characteristics of the eleven intervention communities are examined with a focus on differences in size, location, availability and importance of the intervention channels, and other factors that were important for community mobilization. Initial results of the mobilization process are summarized. Although there were some differences in the structures formed and the time required to complete the initial project activities, all eleven intervention sites were mobilized around the COMMIT goals and activities.
Two approaches to measuring perceptions of synergistic risk were compared, one using the traditional Likert scale, the other using an anchored, relative scale. Perception of synergistic risk was defined as rating the combined hazard as more risky than each of its constituent single hazards. In a within‐subjects design, a convenience sample from the community ( N = 604) rated three hazard combinations and their constituents: Driving while Intoxicated (familiar, high synergy), Radon and Smoking (unfamiliar, high synergy), and Smoking and Driving (familiar, low synergy), on both scales. The relative scale was expected to be a more sensitive measure of synergy than the Likert scale. The effects of item order (single hazards rated first versus combined hazards rated first) were examined between subjects. Driving while Intoxicated was perceived by the large majority of participants as a synergistic risk on both scales, but neither of the other two combined hazards were rated synergistically on either scale. The relative scale demonstrated a slight advantage over the Likert scale, and presenting the single hazards first for the relative scale produced more synergistic ratings. It is recommended that anchored, relative scales be used to measure synergy and that single hazards be presented prior to the combined hazards when using relative scales.
Different types of "relapse crises" and associated coping responses were associated with the resumption of smoking using a prospective design. One hundred and two previously heavy smokers (M = 23.9 cigarettes a day) who achieved initial abstinence through a smoking cessation program were interviewed by telephone at 1, 2, and 3 months posttreatment. At each assessment, subjects described relapse crises, situations in which they were tempted to smoke or actually smoked but resumed abstinence (lapsed). Prospective analyses indicated that any smoking lapse is strongly related to subsequent relapse. Situational characteristics of relapse crises and the number of cognitive and behavioral coping responses reported during crises were only modestly consistent over time and were unrelated to later relapse. Confidence ratings and situational attributions about the relapse crises were also not prospectively associated with eventual relapse. Subanalyses suggested that lapses associated with urges and emotional (guilt) responses and lapses occurring in frequent situations are more likely to result in relapse.
