Seattle 5-a-Day Program

Studies show that higher levels of fruits and vegetables are consistently associated with lower risk of most cancers. The consumption of at least five servings daily of fruits and vegetables, "5-a-Day", was conceived in the 1998 Surgeon General's Report on Nutrition and Health, and continues to be included in Health People 2010 objectives. Unfortunately, only 23% of Americans eat five servings of fruits and vegetables daily. Various avenues for increasing consumption must be explored. Given that employed people spend up to 30% of their waking hours at work, an employee health promotion program may be such an avenue. Besides benefiting the employee directly, employers can profit by containing medical and disability costs, reductions in absenteeism, and an enhanced corporate image.

The Seattle 5-a-Day program is designed for worksites to increase fruit and vegetable consumption. The program's intervention strategies are developed around the stages of change model, addressing the work environment and the individual-level behavior change. Seattle 5-a-Day's protocol defines a general structure for organizing the worksite, for implementing the individualized intervention activities, and for documenting the process. Employee ownership of the program is enhanced through an employee advisory board (EAB). In addition to individually tailored activities, stage specific messages, such as, "Do something groundbreaking," or "5 ways to a 5-a-Day," are delivered to workers through posters, flyers, food demonstrations, and a self-help manual. For the study, EABs were visited every 2 weeks by specialists who provided materials, assisted in activities and participated in EAB meetings.

Seattle 5-a-Day should be tailored to meet the needs of individual worksites.

Participants were employees at worksites within the greater metropolitan area around Seattle. The average age was 41 years old; 60% were female; and 87% were White.  Other participants in the study were Asian or Pacific Islander, Black, Alaskan Native, American Indian, and Hispanic

This intervention is suitable for implementation in a worksite setting.

The Seattle 5-a-Day protocol is required as is the self-help manual, Take Five: A Guide to Healthful Eating. Other materials include posters, brochures, flyers, newsletters, and materials containing the "5-a-Day" message.  Costs associated with the program's implementation are not provided.

For the study, 28 worksites were randomly assigned to either the Seattle 5-a-Day intervention group or the control group. In each intervention worksite, an employee advisory board and research intervention specialist worked together to implement the stage of change program. Worksites followed a minimum intervention protocol that defined the number and types of suggested messages for each stages of change transition point. Messages were delivered through posters, newsletters, table tents, and a self-help manual. Skill building for individuals was emphasized as were worksite changes in the cafeteria, including point-of-purchase displays, signs identifying foods as 5-a-Day foods, spotlights on healthy eating, and, in some instances, incentives for eating more fruits and vegetables. Four self-reported measures were used to determine consumption of fruits and vegetables: a modified food frequency questionnaire (FFQ); the Fat- and Fiber-Related Diet Behavior Questionnaire; multiple 24-hour dietary recalls, and a modified usual-day intake or checklist.

Results indicated:

• At 2-year follow-up, fruit and vegetable consumption for intervention worksites increased by 0.5 and by 0.2 for control worksites for an intervention effect of 0.3 daily serving.