摘要：Objectives. We analyzed outcomes from a study that examined social-contextual factors in cancer prevention interventions for working class, multiethnic populations. Methods. Ten community health centers were randomized to intervention or to control. Patients who resided in low-income, multiethnic neighborhoods were eligible; the intervention targeted fruit and vegetable consumption, red meat consumption, multivitamin intake, and physical activity. Outcomes were measured at 8 months. Results. The intervention led to significant increases in fruit and vegetable consumption and multivitamin intake and reductions in red meat consumption; no change was found in physical activity levels. The intervention effect was not changed when contextual variables that may function as confounders or effect modifiers (e.g., gender, education, race/ethnicity, respondent and parents’ country of birth, and poverty status) were included in the analyses. Conclusions. The intervention led to significant improvements in health behaviors among a working class, multiethnic population, regardless of race/ ethnicity and socioeconomic status. Interventions that respond to the social context of working class individuals across racial/ethnic categories hold promise for improving cancer-related risk behaviors. Disparities in cancer morbidity and mortality rates by race/ethnicity and socioeconomic position have been well documented and are a key research priority. 1 , 2 Across health behaviors, patterns of risk by socioeconomic position remain constant: persons of higher socioeconomic position engage in fewer high-risk behaviors than do persons of lower socioeconomic position. 3 – 5 Similar patterns are found by race/ethnicity. 3 , 6 – 8 The health care system is an important channel for reducing behavioral risk factors among diverse populations. 9 – 11 Brief physician counseling has been found to be effective with diet and tobacco use, 12 – 15 although evidence is currently inconclusive regarding the effect of provider counseling on physical activity. 16 , 17 The rates of physicians providing behavior change counseling are quite low. 18 , 19 Adjuncts to brief provider counseling are effective, 17 and provider interventions may be more effective if patients are referred to other programs that provide ongoing social support. 10 , 20 We present the outcome results of Healthy Directions–Health Centers, an intervention study designed to reduce cancer risk factors among working class, multiethnic populations seen in community health centers. This study was part of the Harvard Cancer Prevention Program Project, the theme of which was to create cancer prevention interventions that are effective with working class, multiethnic populations. This program project was designed to develop and test behavioral interventions for multiple cancer risk factors in working class and ethnically diverse groups through 2 intervention channels: health centers and worksites. The 2 intervention projects (Healthy Directions–Health Centers and Healthy Directions–Small Businesses) were randomized controlled trials that used the organization (e.g., health center or small business) as the unit of randomization and intervention and the individual as the unit of analysis. Both projects used a common conceptual model and intervention paradigm 21 and focused on common primary outcomes: fruit and vegetable consumption, red meat consumption, multivitamin intake, and physical activity. The design of the interventions was largely based on social epidemiological findings related to disparities in health behaviors and health outcomes. Healthy Directions was designed to take into account elements of the social context that are critical components of an ecological approach to health behavior change. We present the outcomes of the 8-month follow-up of the Healthy Directions–Health Centers project.
