The Next Step: Worksite Cancer Screening and Nutrition Intervention

Colorectal cancer is the second most common cancer. Prevention and early detection have the potential to decrease morbidity and prevent premature death from this disease. Colorectal cancer screening combined with a healthful diet low in fat and high in fiber, fruits, and vegetables may reduce the incidence of colorectal cancer and are part of a national cancer control strategy. Colorectal cancer interventions that target high-risk populations hold promise because these persons may be motivated to change their behavior. Moreover, worksite-based nutrition and screening interventions for high risk populations show promise because they are accessible and convenient, can be enhanced by co-worker support, and provide opportunities for reinforcement and environmental supports for healthy eating.

Next Step is a workplace program that aims to increase colorectal cancer screening and promote healthy dietary behaviors. The screening promotion component consists of an invitation flyer and a personalized educational booklet. The booklet explains screening procedures, presents cancer statistics, and includes a personalized screening schedule. The dietary component consists of five nutrition education classes delivered in the workplace, with mailed self-help materials. In the second year of the program, employees receive personalized feedback to encourage maintenance of first-year gains. Worksite cafeterias also display posters and brochures relaying simple messages about low fat, high-fiber eating.

This program uses an intervention approach recommended by the Community Preventive Services Task Force: small media interventions (Colorectal Cancer Screening - FIT/FOBT and/ or with flex sig). This program also uses the following intervention approach for which the Community Preventive Services Task Force finds insufficient evidence: group education interventions (Colorectal Cancer Screening - FIT/FOBT and/ or with flex sig). Insufficient evidence means the available studies do not provide sufficient evidence to determine if the intervention is or is not effective. This does not mean that the intervention does not work. It means that additional research is needed to determine whether the intervention is effective.

The Next Step program is delivered over two years. The educational booklet is delivered once per year. Five, one-hour nutrition education classes are held during the first year of the program. Training for delivering the nutrition classes is 1.5 days.

Study participants were male automobile industry workers aged 19-85 years from Michigan, Ohio, Indiana, New York and Pennsylvania. Of the participants 95% were Caucasian (including an unspecified number of Hispanics), 3% were African American, 2% were classified as "other". The racial/ethnic distribution represented the proportions working in the particular segment of the auto industry being offered the screening program. A total of 38% were retired; and 24% had a history of polyps or colorectal cancer.

The intervention is suitable for implementation in the workplace and the home.

The Leaner the Better screening flyer, ColoRecord educational booklet, Fat & Fiber packet (including all the handouts), The Next Step Procedures Manual, and The Leaner Weigh instructor and participant manual are required. Costs associated with the program are not provided.

Twenty-eight automobile industry worksites were randomized to receive the Next Step program or a company-sponsored screening program. Participants in the Next Step program received an enhanced screening program and a diet-change program. To promote screening, employees received a personalized educational booklet. A follow-up companion telephone call was made to review the booklet and screening schedule, and highlight cancer risks and facts. To promote healthier eating, five nutrition education classes were offered during work time and employees were also mailed self-help materials. In the second year, employees received personalized feedback to encourage maintenance of first-year gains. The feedback consisted of a graphic comparison of the employee's diet to the USDA Food Guide Pyramid and motivational messages based on the employee's responses to a food frequency questionnaire. In addition, worksite cafeterias displayed posters and brochures relaying simple messages about low fat, high-fiber eating, and a quarterly newsletter was also mailed to employees' homes to promote and reinforce intervention strategies. Surveys to measure changes in dietary outcome and screening behavior were mailed at the end of the first and second year of the study.

Results indicated:

• At Year 1 of the program, Next Step participants decreased their energy from fat, and increased their servings of fruits and vegetables.

• At Years 1 and 2, Next Step participants increased their fiber consumption compared to control participants.

• At Year 2, Next Step participants had modest, but higher screening compliance (receiving all recommended examinations) and coverage (receiving at least one recommended examination) compared to participants in the control group.