The Treatwell 5-a-Day Program

Consistent evidence points to the protective role played by consumption of fruits and vegetables in many epithelial cancers. Diet has been estimated to contribute to approximately 35% of all cancer incidence. Despite this strong scientific evidence, research indicates that only 20% to 30% of Americans meet recommendations to consume 5 or more servings of fruits and vegetables per day. Worksites are an ideal channel for promoting dietary change because they (1) provide access to a large segment of the population (approximately 70% of American adults are employed); (2) can be offered repeatedly, thus increasing the likelihood of motivating behavior change in persons who are at various stages of readiness; and (3) permit support for individual behavior change attempts by modifying the environment and social norms. 

The Treatwell 5-a-Day Program aims to increase fruit and vegetable consumption among individuals at the worksite. As a component of a broader health promotion program, Treatwell seeks to build support for behavior change from coworkers, household members, and the worksite environment. Its components include:
-- Periodic exposure to national 5-a-Day media campaigns and promotion of the National Cancer Institute's Cancer Information Service Hot Line (1-800-4CANCER)
-- A 1-hour general nutrition presentation and taste test
-- Creation of an employee advisory board to develop and implement the programs
-- A kick-off event
-- The Eatwell 5-a-Day discussion series, which consists of ten 30-minute sessions on purchasing   and preparing healthful meals
-- At least one educational campaign each year that lasted 3-5 weeks
-- Increasing availability of fruits and vegetables at the workplace
-- Family activities that include a learn-at-home program (Fit-in-5), newsletters and other mailings, and an annual family festival 

Time varies depending on the needs of the worksite as determined by the employee advisory board. For the study, the intervention was implemented over a 20-month period. 

The intended audience for the Treatwell 5-a-Day Program is working adults.

This intervention is suitable for implementation in a worksite setting.

The protocol, Best Practices Manual, is required, and adaptations are encouraged. Costs associated with the program's implementation are not provided.

Twenty-two worksites were randomly assigned to three groups: (1) a minimal intervention control group, (2) a worksite intervention, and (3) a worksite-plus-family intervention (Treatwell). Each of the three groups received three core components: exposure to 5-a-Day media campaigns, promotion of the National Cancer Institute's Cancer Information Service Hotline, and a 1-hour general nutrition presentation and taste test. 

In addition to the core components, the worksite and worksite-plus-family intervention conditions included (1) worker participation in program planning and implementation, (2) programs to change individual behavior (e.g., taste tests, self-assessments with feedback, contests), and (3) programs to change the worksite environment (e.g., healthy snacks in break rooms and vending machines; the placement of posters, videos, and brochures in places where employees eat).

The worksite-plus-family condition also included (1) a written learn-at-home program, "Fit in 5", (2) an annual family newsletter, (3) an annual family festival, and (4) periodic mailings of materials to families. 

• The worksite-plus-family intervention (Treatwell) was more successful in increasing fruit and vegetable consumption than the control condition. On average, workers in the worksite-only intervention group reported a 7% increase in consumption and those in the worksite-plus-family condition reported a 19% increase (p=.02), while the control group reported no significant change in their consumption.