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Meta-Analysis
. 2018 Nov 14;11(11):CD012439.
doi: 10.1002/14651858.CD012439.pub2.

Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity

Luke Wolfenden  1 , Sharni Goldman, Fiona G Stacey, Alice Grady, Melanie Kingsland, Christopher M Williams, John Wiggers, Andrew Milat, Chris Rissel, Adrian Bauman, Margaret M Farrell, France Légaré, Ali Ben Charif, Hervé Tchala Vignon Zomahoun, Rebecca K Hodder, Jannah Jones, Debbie Booth, Benjamin Parmenter, Tim Regan, Sze Lin Yoong
Affiliations
Meta-Analysis

Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity

Luke Wolfenden et al. Cochrane Database Syst Rev. .

Abstract

Background: Given the substantial period of time adults spend in their workplaces each day, these provide an opportune setting for interventions addressing modifiable behavioural risk factors for chronic disease. Previous reviews of trials of workplace-based interventions suggest they can be effective in modifying a range of risk factors including diet, physical activity, obesity, risky alcohol use and tobacco use. However, such interventions are often poorly implemented in workplaces, limiting their impact on employee health. Identifying strategies that are effective in improving the implementation of workplace-based interventions has the potential to improve their effects on health outcomes.

Objectives: To assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use.Secondary objectives were to assess the impact of such strategies on employee health behaviours, including dietary intake, physical activity, weight status, and alcohol and tobacco use; evaluate their cost-effectiveness; and identify any unintended adverse effects of implementation strategies on workplaces or workplace staff.

Search methods: We searched the following electronic databases on 31 August 2017: CENTRAL; MEDLINE; MEDLINE In Process; the Campbell Library; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Scopus. We also handsearched all publications between August 2012 and September 2017 in two speciality journals: Implementation Science and Journal of Translational Behavioral Medicine. We conducted searches up to September 2017 in Dissertations and Theses, the WHO International Clinical Trials Registry Platform, and the US National Institutes of Health Registry. We screened the reference lists of included trials and contacted authors to identify other potentially relevant trials. We also consulted experts in the field to identify other relevant research.

Selection criteria: Implementation strategies were defined as strategies specifically employed to improve the implementation of health interventions into routine practice within specific settings. We included any trial with a parallel control group (randomised or non-randomised) and conducted at any scale that compared strategies to support implementation of workplace policies or practices targeting diet, physical activity, obesity, risky alcohol use or tobacco use versus no intervention (i.e. wait-list, usual practice or minimal support control) or another implementation strategy. Implementation strategies could include those identified by the Effective Practice and Organisation of Care (EPOC) taxonomy such as quality improvement initiatives and education and training, as well as other strategies. Implementation interventions could target policies or practices directly instituted in the workplace environment, as well as workplace-instituted efforts encouraging the use of external health promotion services (e.g. gym membership subsidies).

Data collection and analysis: Review authors working in pairs independently performed citation screening, data extraction and 'Risk of bias' assessment, resolving disagreements via consensus or a third reviewer. We narratively synthesised findings for all included trials by first describing trial characteristics, participants, interventions and outcomes. We then described the effect size of the outcome measure for policy or practice implementation. We performed meta-analysis of implementation outcomes for trials of comparable design and outcome.

Main results: We included six trials, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services-based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point-of-purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. Four trials compared an implementation strategy intervention with a no intervention control, one trial compared different implementation interventions, and one three-arm trial compared two implementation strategies with each other and a control. Four trials reported a single implementation outcome, whilst the other two reported multiple outcomes. Investigators assessed outcomes using surveys, audits and environmental observations. We judged most trials to be at high risk of performance and detection bias and at unclear risk of reporting and attrition bias.Of the five trials comparing implementation strategies with a no intervention control, pooled analysis was possible for three RCTs reporting continuous score-based measures of implementation outcomes. The meta-analysis found no difference in standardised effects (standardised mean difference (SMD) -0.01, 95% CI -0.32 to 0.30; 164 participants; 3 studies; low certainty evidence), suggesting no benefit of implementation support in improving policy or practice implementation, relative to control. Findings for other continuous or dichotomous implementation outcomes reported across these five trials were mixed. For the two non-randomised trials examining comparative effectiveness, both reported improvements in implementation, favouring the more intensive implementation group (very low certainty evidence). Three trials examined the impact of implementation strategies on employee health behaviours, reporting mixed effects for diet and weight status (very low certainty evidence) and no effect for physical activity (very low certainty evidence) or tobacco use (low certainty evidence). One trial reported an increase in absolute workplace costs for health promotion in the implementation group (low certainty evidence). None of the included trials assessed adverse consequences. Limitations of the review included the small number of trials identified and the lack of consistent terminology applied in the implementation science field, which may have resulted in us overlooking potentially relevant trials in the search.

Authors' conclusions: Available evidence regarding the effectiveness of implementation strategies for improving implementation of health-promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost-effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting.

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Conflict of interest statement

Luke Wolfenden: none known.

Sharni Goldman: none known.

Fiona Stacey: none known.

Alice Grady: none known.

Melanie Kingsland: none known.

Christopher M Williams: none known.

John Wiggers: none known.

Andrew Milat: none known.

Chris Rissel: none known.

Adrian Bauman: none known.

Margaret M Farrell: none known.

France Légaré: none known.

Ali Ben Charif: none known.

Hervé Tchala Vignon Zomahoun: none known.

Rebecca K Hoder: none known.

Jannah Jones: none known.

Debbie Booth: none known.

Benjamin Parmenter: none known.

Tim Regan: none known.

Sze Lin Yoong: none known.

Figures

1
1
Review logic model
2
2
Study selection flow diagram.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
5
5
Forest plot of comparison: 1 Implementation strategy versus control, outcome: 1.1 Implementation score.
1.1
1.1. Analysis
Comparison 1 Implementation strategy versus control, Outcome 1 Implementation score.
See this image and copyright information in PMC

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    1. Christensen JR, Faber A, Ekner D, Overgaard K, Holtermann A, Sogaard K. Diet, physical exercise and cognitive behavioral training as a combined workplace based intervention to reduce body weight and increase physical capacity in health care workers ‐ a randomized controlled trial. BMC Public Health 2011;11(671):1‐11. [DOI: 10.1186/1471-2458-11-671] - DOI - PMC - PubMed
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    1. Coeffeng JK, Boot CR, Duijts SF, Twisk JW, Mechelen W, Hendriksen IJ. Effectiveness of a worksite social & physical environment intervention on need for recovery, physical activity and relaxation; results of a randomized controlled trial. PLOS ONE 2014;9(12):1‐26. [DOI: 10.1371/journal.pone] - DOI - PMC - PubMed
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    1. Cook RF, Billings DW, Hersch RK, Back AS, Hendrickson A. A field test of a web‐based workplace health promotion program to improve dietary practices, reduce stress, and increase physical activity: randomized controlled trial. Journal of Medical Internet Research 2007;9(2):e17. [DOI: 10.2196/jmir.9.2.e17] - DOI - PMC - PubMed
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Crawford 2004 {published data only}
    1. Crawford PB, Gosliner W, Strode P, Samuels SE, Burnett C, Craypo L, et al. Walking the talk: fit WIC wellness programs improve self‐efficacy in pediatric obesity prevention counseling. American Journal of Public Health 2004;94(9):1480‐5. - PMC - PubMed
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    1. Cremaschini M, Moretti R, Brembilla G, Valoti M, Sarnataro F, Spada P, et al. Assessment of the impact over one year of a workplace health promotion programme in the province of Bergamo. La Medicina Del Lavoro 2015;106(3):159‐71. - PubMed
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    1. Dalager T, Justesen JB, Sjogaard G. Intelligent physical exercise training in a workplace setting improves muscle strength and musculoskeletal pain: a randomized controlled trial. BioMed Research International 2017;Article ID 7914134:1‐9. [DOI: 10.1155/2017/7914134] - DOI - PMC - PubMed
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    1. Dallat MT, Hunter RF, Tully MA, Cairns KJ, Kee F. A lesson in business: cost‐effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace. BMC Public Health 2013;13(953):1‐9. [DOI: 10.1186/1471-2458-13-953] - DOI - PMC - PubMed
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    1. Dishman RK, Vandenberg RJ, Motl RW, Wilson MG, DeJoy DM. Dose relations between goal setting, theory‐based correlates of goal setting and increases in physical activity during a workplace trial. Health Education Research 2010;25(4):620‐31. [DOI: 10.1093/her/cyp042] - DOI - PubMed
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    1. Dubuy V, Cocker K, Bourdeaudhuij I, Maes L, Seghers J, Lefevre J, et al. Evaluation of a workplace intervention to promote commuter cycling: a RE‐AIM analysis. BMC Public Health 2013;13(587):1‐11. [DOI: 10.1186/1471-2458-13-587] - DOI - PMC - PubMed
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    1. Dutta N, Koepp GA, Stovitz SD, Levine JA, Pereira MA. Using sit‐stand workstations to decrease sedentary time in office workers: a randomized crossover trial. International Journal of Environmental Research and Public Health 2014;11:6653‐65. [DOI: 10.3390/ijerph110706653] - DOI - PMC - PubMed
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    1. Edries N, Jelsma J, Maart S. The impact of an employee wellness programme in clothing/textile manufacturing companies: a randomised controlled trial. BMC Public Health 2013;13(25):1‐9. [DOI: 10.1186/1471-2458-13-25] - DOI - PMC - PubMed
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Erfurt 1991 {published data only}
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    1. Ford MA, Haskins MA, Wade C. Weight management through motivational counseling in the workplace. Journal of Safety, Health and Environmental Research 2014;10(2):178‐83.
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    1. Freak‐Poli R, Wolfe R, Brand M, Courten M, Peeters A. Eight‐month postprogram completion: change in risk factors for chronic disease amongst participants in a 4‐month pedometer‐based workplace health program. Obesity 2013;21(9):E360‐8. [DOI: 10.1002/oby.20342] - DOI - PubMed
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    1. Geaney F, Scotto Di Marrazzo J, Kelly C, Fitzgerald AP, Harrington JM, Kirby A, et al. The food choice at work study: effectiveness of complex workplace dietary interventions on dietary behaviours and diet‐related disease risk ‐ study protocol for a clustered controlled trial. Trials 2013;14(370):1‐14. [DOI: 10.1186/1745-6215-14-370] - DOI - PMC - PubMed
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    1. Glasgow RE, Sorensen G, Giffen C, Shipley RH, Corbett K, Lynn W. Promoting worksite smoking control policies and actions: the community intervention trial for smoking cessation (COMMIT) experience. Preventive Medicine 1996;25(2):186‐94. [DOI: 10.1006/pmed.1996.0045] - DOI - PubMed
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    1. Gosliner WA, James P, Yancey AK, Ritchie L, Studer N, Crawford PB. Impact of a worksite wellness program on the nutrition and physical activity environment of child care centers. American Journal of Health Promotion 2010;24(3):186‐9. [DOI: 10.4278/ajhp.08022719] - DOI - PubMed
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Griffin‐Blake 2006 {published data only}
    1. Griffin‐Blake CS, DeJoy DM. Evaluation of social‐cognitive versus stage‐matched, self‐help physical activity interventions at the workplace. American Journal of Health Promotion 2006;20(3):200‐9. [DOI: 10.4278/0890-1171-20.3.200] - DOI - PubMed
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    1. Groeneveld IF, Proper KI, Beek AJ, Duivenbooden C, Mechelen W. Design of a RCT evaluating the (cost‐) effectiveness of a lifestyle intervention for male construction workers at risk for cardiovascular disease: the health under construction study. BMC Public Health 2008;8(1):1‐12. [DOI: 10.1186/1471-2458-8-1] - DOI - PMC - PubMed
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    1. Hadgraft NT, Winkler EAH, Healy GN, Lynch BM, Neuhaus M, Eakin EG, et al. Intervening to reduce workplace sitting: mediating role of social‐cognitive constructs during a cluster randomised controlled trial. International Journal of Behavioral Nutrition and Physical Activity 2017;14(27):1‐9. [DOI: 10.1186/s12966-017-0483-1] - DOI - PMC - PubMed
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    1. Hagger MS, Lonsdale A, Chatzisarantis NL. Effectiveness of a brief intervention using mental simulations in reducing alcohol consumption in corporate employees. Psychology, Health & Medicine 2011;16(4):375‐92. [DOI: 10.1080/13548506.2011.554568] - DOI - PubMed
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    1. Hall J, Mansfield L, Kay T, McConnell A. The effect of a sit‐stand workstation intervention on daily sitting, standing and physical activity: protocol for a 12 month workplace randomised control trial. BMC Public Health 2015;15(152):1‐9. [DOI: 10.1186/s12889-015-1506-y] - DOI - PMC - PubMed
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    1. Harden SM, Johnson SB, Almeida FA, Estabrooks PA. Improving physical activity program adoption using integrated research‐practice partnerships: an effectiveness‐implementation trial. Translational Behavioral Medicine 2017;7(1):28‐38. [DOI: 10.1007/s13142-015-0380-6] - DOI - PMC - PubMed
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    1. Harley AE, Devine CM, Beard B, Stoddard AM, Hunt MK, Sorensen G. Multiple health behavior changes in a cancer prevention intervention for construction workers, 2001‐2003. Preventing Chronic Disease 2010;7(3):1‐12. - PMC - PubMed
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    1. Harley AE, Sapp AL, Li Y, Marino M, Quintiliani LM, Sorensen G. Sociodemographic and social contextual predictors of multiple health behavior change: data from the Healthy Directions–Small Business study. Translational Behavioral Medicine 2013;3(1):131‐9. [DOI: 10.1007/s13142-013-0196-1] - DOI - PMC - PubMed
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    1. Hebert JR, Harris DR, Sorensen G, Stoddard AM, Hunt MK, Morris DH. A work‐site nutrition intervention: its effects on the consumption of cancer‐related nutrients. American Journal of Public Health 1993;83(3):391‐4. - PMC - PubMed
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    1. Hebert JR, Stoddard AM, Harris DR, Sorensen G, Hunt MK, Morris DH, et al. Measuring the effect of a worksite‐based nutrition intervention on food consumption. Annals of Epidemiology 1993;3(6):629‐35. - PubMed
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    1. Holtermann A, Jorgensen MB. Gram B, Christensen JR, Faber A, Overgaard K. Worksite interventions for preventing physical deterioration among employees in job‐groups with high physical work demands: Background, design and conceptual model of FINALE. BMC Public Health 2010;10(120):1‐12. [DOI: 10.1186/1471-2458-10-120] - DOI - PMC - PubMed
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    1. Hopkins JM. Understanding Key Players and Factors Involved in the Implementation of Physical Activity Push Strategies into Organizational Settings [PhD thesis]. Los Angeles (USA): University of California, Los Angeles, 2012.
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Hunt 2000 {published data only}
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Hunt 2003 {published data only}
    1. Hunt MK, Stoddard AM, Barbeau E, Goldman R, Wallace L, Gutheil C, et al. Cancer prevention for working class, multiethnic populations through small businesses: the healthy directions study. Cancer Causes & Control 2003;14(8):749‐60. - PubMed
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    1. Hunt MK, Fagan P, Lederman R, Stoddard A, Frazier L, Girod K, et al. Feasibility of implementing intervention methods in an adolescent worksite tobacco control study. Tobacco Control 2003;12(Suppl IV):iv40‐45. - PMC - PubMed
Hunt 2007 {published data only}
    1. Hunt MK, Barbeau EM, Lederman R, Stoddard AM, Chetkovich C, Goldman R, et al. Process evaluation results from the Healthy Directions‐Small Business study. Health Education & Behavior 2007;34(1):90‐107. [DOI: 10.1177/1090198105277971] - DOI - PubMed
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    1. Hunt MK, Lederman R, Stoddard AM, LaMontagne AD, McLellan D, Combe C, et al. Process evaluation of an integrated health promotion/occupational health model in WellWorks‐2. Health Education & Behavior 2005;32(1):10‐26. [DOI: 10.1177/1090198104264216] - DOI - PubMed
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    1. Hunt MK, Harley AE, Stoddard AM, Lederman RI, MacArthur MJ, Sorensen G. Elements of external validity of tools for health: an intervention for construction laborers. American Journal of Health Promotion 2010;24(5):e11‐e20. [DOI: 10.4278/ajhp.080721-QUAN-130] - DOI - PubMed
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    1. Pidd K, Roche A, Fischer J. A recipe for good mental health: a pilot randomised controlled trial of a psychological wellbeing and substance use intervention targeting young chefs. Drugs: Education, Prevention and Policy 2015;22(4):353‐61. [DOI: 10.3109/09687637.2015.1016400] - DOI
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    1. Plotnikoff RC, McCargar LJ, Wilson PM, Loucaides CA. Efficacy of an e‐mail intervention for the promotion of physical activity and nutrition behavior in the workplace context. American Journal of Health Promotion 2005;19(6):422‐9. [DOI: 10.4278/0890-1171-19.6.422] - DOI - PubMed
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    1. Prestwich A, Conner MT, Lawton RJ, Ward JK, Ayres K, McEachan RR. Randomized controlled trial of collaborative implementation intentions targeting working adults' physical activity. Health Psychology 2012;31(4):486‐95. [DOI: 10.1037/a0027672] - DOI - PubMed
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Purath 2004 {published data only}
    1. Purath J, Miller AM, McCabe G, Wilbur J. A brief intervention to increase physical activity in sedentary working women. Canadian Journal of Nursing Research 2004;36(1):76‐91. - PubMed
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    1. Reynolds KD, Gillum JL, Hyman DJ, Byers T, Moore SA, Paradis G. Comparing two strategies to modify dietary behavior and serum cholesterol. European Journal of Preventive Cardiology 1997;4(1):1‐5. [DOI: 10.1177/174182679700400101] - DOI - PubMed
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    1. Riley KE, Park CL, Wilson A, Sabo AN, Antoni AM, Braun TD, et al. Improving physical and mental health in frontline mental health care providers: yoga‐based stress management versus cognitive behavioral stress management. Journal of Workplace Behavioral Health 2017;32(1):26‐48. [DOI: 10.1080/15555240.2016.1261254] - DOI - PMC - PubMed
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    1. Robroek SJ, Lindeboom DE, Burdorf A. Initial and sustained participation in an internet‐delivered long‐term worksite health promotion program on physical activity and nutrition. Journal of Medical Internet Research 2012;14(2):e43. [DOI: 10.2196/jmir.1788] - DOI - PMC - PubMed
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    1. Schaller A, Dejonghe L, Alayli‐Goebbels A, Biallas B, Froboese I. Promoting physical activity and health literacy: study protocol for a longitudinal, mixed methods evaluation of a cross‐provider workplace‐related intervention in Germany (the AtRisk study). BMC Public Health 2016;16(626):1‐10. [DOI: 10.1186/s12889-016-3284-6] - DOI - PMC - PubMed
Schneider 2016 {published data only}
    1. Schneider PL, Bassett DR, Rider BC, Saunders SS. Physical activity and motivating factors of participants in a financially incentivized worksite wellness program. International Journal of Health Promotion and Education 2016;54(6):295‐303. [DOI: 10.1080/14635240.2016.1174951] - DOI
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    1. Schwartz B, Kappellush JM, Schrempf A, Probst K, Haller M, Baca A. Effect of a novel two‐desk sit‐to‐stand workplace (ACTIVE OFFICE) on sitting time, performance and physiological parameters: protocol for a randomized control trial. BMC Public Health 2016;16(578):1‐10. [DOI: 10.1186/s12889-016-3271-y] - DOI - PMC - PubMed
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Sforzo 2012 {published data only}
    1. Sforzo GA, Kaye MP, Calleri D, Ngai N. Free choice access to multipoint wellness education and related services positively impacts employee wellness: a randomized and controlled trial. Journal of Occupational and Environmental Medicine 2012;54(4):471‐7. [DOI: 10.1097/JOM.0b013e3182479f5c] - DOI - PubMed
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Smith‐McLallen 2017 {published data only}
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Sorensen 1990 {published data only}
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Sorensen 1992 {published data only}
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Sorensen 1992b {published data only}
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    1. Sorensen G, Stoddard A, Hunt MK, Hebert JR, Ockene JK, Avrunin JS, et al. The effects of a health promotion‐health protection intervention on behavior change: the WellWorks Study. American Journal of Public Health 1998;88(11):1685‐90. - PMC - PubMed
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    1. Sorensen G, Stoddard A, Peterson K, Cohen N, Hunt MK, Stein E, et al. Increasing fruit and vegetable consumption through worksites and families in the Treatwell 5‐a‐day study. American Journal of Public Health 1999;89(1):54‐60. - PMC - PubMed
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Sorensen 2005 {published data only}
    1. Sorensen G, Barbeau E, Stoddard AM, Hunt MK, Kaphingst K, Wallace L. Promoting behavior change among working‐class, multiethnic workers: results of the healthy directions‐small business study. American Journal of Public Health 2005;95(8):1389‐95. [DOI: 10.2105/AJPH.2004.038745] - DOI - PMC - PubMed
Sorensen 2007 {published data only}
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    1. Terry PE, Seaverson EL, Staufacker MJ, Tanaka A. The effectiveness of a telephone‐based tobacco cessation program offered as part of a worksite health promotion program. Population Health Management 2011;14(3):117‐25. [DOI: 10.1089/pop.2010.0026] - DOI - PubMed
Terry 2011b {published data only}
    1. Terry PE, Fowles JB, Xi M, Harvey L. The ACTIVATE study: results from a group‐randomized controlled trial comparing a traditional worksite health promotion program with an activated consumer program. American Journal of Health Promotion 2011;26(2):e64‐73. [DOI: 10.4278/ajhp.091029-QUAN-348] - DOI - PubMed
Terry 2011c {published data only}
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Thogersen‐Ntoumani 2010 {published data only}
    1. Thogersen‐Ntoumani C, Loughren EA, Duda JL, Fox KR, Kinnafick FE. "Step by Step". A feasibility study of a lunchtime walking intervention designed to increase walking, improve mental well‐being and work performance in sedentary employees: rationale and study design. BMC Public Health 2010;10(578):1‐9. [DOI: 10.1186/1471-2458-10-578] - DOI - PMC - PubMed
Thompson 1995 {published data only}
    1. Thompson B, Shannon J, Beresford SAA. Implementation aspects of the Seattle “5 a Day” intervention project: strategies to help employees make dietary change. Topics in Clinical Nutrition 1995;11:58‐75.
Thorndike 2012 {published data only}
    1. Thorndike AN, Sonnenberg L, Healey E, Myint‐U K, Kvedar JC, Regan S. Prevention of weight gain following a worksite nutrition and exercise program: a randomized controlled trial. American Journal of Preventive Medicine 2012;43(1):27‐33. [DOI: 10.1016/j.amepre.2012.02.029] - DOI - PMC - PubMed
Tilley 1997 {published data only}
    1. Tilley BC, Vernon SW, Glanz K, Myers R, Sanders K, Lu M, et al. Worksite cancer screening and nutrition intervention for high‐risk auto workers: design and baseline findings of the Next Step Trial. Preventive Medicine 1997;26(2):227‐35. [DOI: 10.1006/pmed.1996.0132] - DOI - PubMed
Tilley 1998 {published data only}
    1. Tilley BC, Vernon SW, Myers R, Glanz K, Lu M, Hirst K, et al. The Next Step Trial: impact of a worksite colorectal cancer screening promotion program. Preventive Medicine 1998;28(3):276‐83. [DOI: 10.1006/pmed.1998.0427] - DOI - PubMed
Tilley 1999 {published data only}
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Tobin 2016 {published data only}
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Togami 2008 {published data only}
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Townsend 2016 {published data only}
    1. Townsend CK, Miyamoto RE, Antonio M, Zhang G, Paloma D, Basques D, et al. The PILI@Work Program: a translation of the diabetes prevention program to Native Hawaiian‐serving worksites in Hawai'i. Translational Behavioral Medicine 2016;6(2):190‐201. [DOI: 10.1007/s13142-015-0383-3] - DOI - PMC - PubMed
Tucker 2016 {published data only}
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Watanabe 2017 {published data only}
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    1. Weinhold KR, Miller CK, Marrero DG, Nagaraja HN, Focht BC, Gascon GM. A randomized controlled trial translating the diabetes prevention program to a university worksite, Ohio, 2012‐2014. Preventing Chronic Disease 2015;E210:1‐15. [DOI: 10.5888/pcd12.150301] - DOI - PMC - PubMed
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    1. Wilson MG, DeJoy DM, Vandenberg RJ, Corso P, Padilla H, Zuercher H. Effect of intensity and program delivery on the translation of diabetes prevention program to worksites: a randomized controlled trial of Fuel Your Life. Journal of Occupational and Environmental Medicine 2016;58(11):1113‐20. [DOI: 10.1097/JOM.0000000000000873] - DOI - PMC - PubMed
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    1. Wilson MG, DeJoy DM, Vandenberg R, Padilla H, Davis M. FUEL Your Life: a translation of the diabetes prevention program to worksites. American Journal of Health Promotion 2016;30(3):188‐97. [DOI: 10.4278/ajhp.130411-QUAN-169] - DOI - PubMed
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    1. Zinn C, Schofield GM, Hopkins WG. A "small‐changes" workplace weight loss and maintenance program: examination of weight and health outcomes. Journal of Occupational and Environmental Medicine 2012;54(10):1230‐8. [DOI: 10.1097/JOM.0b013e3182480591] - DOI - PubMed
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    1. Zinn C, Schofield GM, Hopkins WG. Efficacy of a "small‐changes" workplace weight loss initiative on weight and productivity outcomes. Journal of Occupational and Environmental Medicine 2012;54(10):1224‐9. [DOI: 10.1097/JOM.0b013e3182440ac2] - DOI - PubMed

References to ongoing studies

Hannon 2016 {published data only}
    1. Hannon PA, Hammerback K, Allen CL, Parrish AT, Chan GK, Kohn MJ, et al. HealthLinks randomized controlled trial: design and baseline results. Contemporary Clinical Trials 2016;48:1‐11. [DOI: 10.1016/j.cct.2016.02.011] - DOI - PMC - PubMed
NCT02381938 {published data only}
    1. Linnan L, Arandia G, Bateman LA, Vaughn A, Smith N, Ward D. The health and working conditions of women employed in child care. International Journal of Environmental Research and Public Health 2017;14(283):1‐14. [DOI: 10.3390/ijerph14030283] - DOI - PMC - PubMed
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NCT02899442 {published data only}
    1. NCT02899442. Cardiovascular risk prevention among night workers (Heart‐Of‐Night). clinicaltrials.gov/ct2/show/study/NCT02899442 (first received 14 September 2016).
Vasiljevic 2017 {published data only}
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