Promoting Healthy Living:
Assessing More Effects (PHLAME II)
Principal Investigator:
Diane L. Elliot, M.D.
Abstract:
Fire fighters are a high-risk
group. Despite strict requirements to become a fire fighter and physically
demanding jobs, professional fire fighters have a high prevalence of sedentary
lifestyles, obesity, hypertension, dyslipidemia,
certain malignancies and chronic musculoskeletal complaints. Their cardiovascular risk factors, combined
with periodically physically challenging work involving extreme heat and urgent
life-threatening situations, account for heart attacks causing more than half
of their on-the-job deaths. Although regular physical activity and a healthy
diet can prevent and treat illnesses and prolong life, similar to most
Americans, fire fighters often do neither.
This proposal, PHLAME II (Promoting Healthy Living: Assessing More
Effects), builds on our original Behavior Change Consortium, NIH-funded study
and further advances understanding of behavior change and its two interventions
([1] team-centered, peer led, scripted TEAM curriculum and [2] one-on-one
motivational interviewing [MI] for health promotion), both shown to
significantly promote participants' healthy nutrition and physical activity
habits, albeit by different mechanisms. The proposal's three primary components
are 1) longitudinally assess original PHLAME participants' health behaviors and
use advanced statistical techniques to compare the original three groups,
define mediators of durability/ lapses for immediate and longer-term outcomes
and identify for whom and under what conditions interventions appear most
effective; 2) code previously recorded motivational interviews and relate
content to outcomes; and 3) partner with national organizations of fire
fighters to disseminate and assess the PHLAME TEAM program. The investigators
and consultants benefit from their initial PHLAME experience, established
credibility with subjects, predefined protocols and in-place techniques for
data management. We welcome the opportunity to continue our collaborations with
other health promotion researchers in addressing compelling questions and
advancing these critical aspects of our nation's health.
Specific Aims:
A.
Perform longitudinal assessments of original PHLAME
(Promoting Healthy Lifestyles: Alternative Models’ Effects) participants.
1. Administer an annual repeated measure assessment battery, (comparable to the original PHLAME study), using in-station assessments in spring 2004, 2005, and 2006 and testing in the Human Performance Laboratory (HPL) at Oregon Health & Science University (OHSU) in spring 2007.
a. Initiate newer computerized web-based tracking of shorter interval changes in study outcome behaviors.
2. Use advanced analytic techniques with the original PHLAME and new prospectively obtained data.
a. Continue to assess differences among the three original PHLAME groups. Assess durability of change and identify mediators and moderators of sustained/lapsed healthy behaviors.
b. Determine how the interventions result in effects by defining and ranking mediating variables/constructs for immediate and longer-term outcomes.
c. Define characteristics of individuals making positive changes and profile for whom and under what conditions each intervention appears most effective.
d. Continue to assess impact of the program on injury rate, sick time and health care expenditures.
3. Obtain quantitative information, including effects of broader job-related Department/Bureau/ District-wide, environmental and socioeconomic influences that facilitate or impede acquisition and maintenance of healthy lifestyle behaviors, and inform the ongoing quantitative assessments (also used with AIM C).
B. Better understand the process and outcomes of motivational interviewing (MI).
1. Reliably code MI interactions using the Motivational Interviewing Skill Code (MISC) system.
a. Facilitate the coding analyses by computerizing the coding system.
2. Use advanced analytic techniques with coding results and the original/subsequent PHLAME data to relate outcome behaviors to fidelity and ‘dose’ of MI, specific counselor verbal behaviors and client characteristics.
3. Validate predictors of MI efficacy by applying information learned about effective MI and those most affected by MI with PHLAME’s original control group fire fighters.
C. Prospectively assess the dissemination, implementation and effects of the PHLAME TEAM health promotion program in more ‘real-world’ contexts.
1. Complete curriculum revisions, including module on alcohol use and supplement/ performance enhancing/stimulant drug use, and prepare the refined curriculum materials (Squad Leader Manual, Workbook, Elective Modules and Fire Fighter Health & Fitness Guide).
2.
Recruit/implement the TEAM program in three fire
stations in each of three
a. Maintain and enhance an information infrastructure to support TEAM program implementation, including a web-based, password protected PHLAME TEAM participant section.
b. Document the dissemination process, (e.g., recruitment, decision to use, implementation, fidelity), and advance understanding of factors that enhance or impede effective transfer of health promotion interventions, relating to the program, individuals, fire fighter teams and the Fire Department.
3. Assess effects of the TEAM program on participants’ four targeted healthy lifestyle behaviors and use of dietary supplements, performance enhancing agents and alcohol.