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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): Alaska Natives (ANs) suffer from some of the most dramatic health disparities of any racial/ethnic group in the U.S. but few system-wide interventions among ANs have been tested. Workplaces are powerful sites for interventions because they provide access to ANs, as well as communication and financial infrastructures. In 2003, the federal government issued a call to action to the nation's employers to implement workplace health promotion interventions aimed at chronic diseases. The U.S. Preventive Services Task Force and the Task Force on Community Preventive Services have recommended 15 practices employers should provide such as health insurance benefits, policies, programs, and communication/tracking systems. These practices help employees increase 1) colon cancer screening, 2) healthy eating, 3) influenza immunization, 4) mammography use, 5) Pap smear use, 6) physical activity, and 6) tobacco cessation treatment. We have created an evidence-based comprehensive workplace intervention package that has successfully helped non-Native employees increase these behaviors. We propose a randomized, controlled trial to evaluate this workplace intervention among AN employees. Our aims are to 1) test the efficacy of a package of intervention strategies, polices, programs, and benefits in AN workplaces, 2) examine if employee-level characteristics are associated with effects of the intervention, 3) describe the relation between intervention processes (e.g., delivery of specific intervention components) and outcomes (e.g., change in policies), and 4) estimate the program's cost effectiveness. A total of 40 AN workplaces will complete baseline surveys on their benefits, programs, and policies and a random sample of their employees will be surveyed about health practices. In the first 2-years, we will work with workplace committees, structures, and employees to adapt and implement the intervention package. Two years after implementation, we will re-administer baseline measures and also assess contamination, intervention implementation, and delivery and receipt of the intervention. Our main outcome is the proportion of possible workplace activities implemented at each time point. The working environments and needs of AN people, and the striking health disparities they suffer from, call for formative research to test such an intervention. Our numerous community partners are critical to the project's success and its ultimate acceptance and dissemination in AN workplaces.