title: Weight gain prevention in the school worksite setting: results of a multi-level cluster randomized trial.
abstract: OBJECTIVE
  To describe the effectiveness, reach and implementation of a weight gain prevention intervention among public school employees.
  
  
  METHODS
  A multi-level intervention was tested in a cluster randomized trial among 782 employees in 12 central Massachusetts public high schools from 2009 to 2012. The intervention targeted the nutrition and physical activity environment and policies, the social environment and individual knowledge, attitudes and skills. The intervention was compared to a materials only condition. The primary outcome measures were change in weight and body mass index (BMI) at 24-month follow-up. Implementation of physical environment, policy and social environment strategies at the school and interpersonal levels, and intervention participation at the individual level were assessed.
  
  
  RESULTS
  At 24-month follow-up, there was a net change (difference of the difference) of -3.03 pounds (p=.04) and of -.48 BMI units (p=.05) between intervention and comparison conditions. The majority of intervention strategies were successfully implemented by all intervention schools, although establishing formal policies was challenging. Employee participation in programs targeting the physical and social environment was maintained over time.
  
  
  CONCLUSIONS
  This study supports that a multi-level intervention integrated within the organizational culture can be successfully implemented and prevent weight gain in public high school employees.
authors.affiliation: University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: Stephenie.Lemon@umassmed.edu.
authors.forename: Stephenie C
authors.initials: SC
authors.lastname: Lemon
authors.affiliation: University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: Monica.Wang@umassmed.edu.
authors.forename: Monica L
authors.initials: ML
authors.lastname: Wang
authors.affiliation: University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: Nicole.Wedick@umassmed.edu.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Wedick
authors.affiliation: University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: Barbara.Estabrook@umassmed.edu.
authors.forename: Barbara
authors.initials: B
authors.lastname: Estabrook
authors.affiliation: University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: Susan.Druker@umassmed.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: Druker
authors.affiliation: Rosalind Franklin University of Medicine and Science, Department of Psychology, 3333 Green Bay Road, North Chicago, IL 60064, USA. Electronic address: Kristin.Schneider@rosalindfranklin.edu.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Schneider
authors.affiliation: University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: Wenjun.Li@umassmed.edu.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.affiliation: University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: Lori.Pbert@umassmed.edu.
authors.forename: Lori
authors.initials: L
authors.lastname: Pbert
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016000:Cluster Analysis; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D009784:Occupational Diseases / Q000517:prevention & control; D009786:Occupational Health Services / Q000706:statistics & numerical data*; D015279:Organizational Culture; D016134:Organizational Policy; D050177:Overweight / Q000517:prevention & control*; D015397:Program Evaluation; D012574:Schools; D012931:Social Environment; D015430:Weight Gain; D000078329:Workforce; D017132:Workplace / Q000523:psychology; D055815:Young Adult
keywords: Ecological model; Environmental interventions; Obesity prevention; Program evaluation; Worksite health promotion