Factors influencing participation rates and employees' attitudes toward promoting healthy eating at blue-collar worksites

In public health policy, the accumulation of risk factors among groups with a short education is a challenge [1]. In Copenhagen, Denmark, life expectancy was found to be 7.4 years longer for 30-year-old men with a high educational level compared with those with a low level [2]. At the same time, short education has been associated with both physical inactivity and unhealthy eating, which are factors linked to increased risk of a number of illnesses, including obesity, cardiovascular diseases, many forms of cancer and Type 2 diabetes [3–6]. Therefore, there is a great need for populationbased strategies to improve food habits with emphasis on reducing socioeconomic disparities [6–8]. In terms of environmental interventions aiming at promoting healthy habits among adults, available data suggest that worksites and universities have the most potential for success [9]. However, according to prior reports, blue-collar workers are less likely to participate in worksite health promotion programs than white-collar workers [10]. Sorensen et al. [11] conclude that methods to encourage worker participation are much needed. Obstacles in participation in health promotion activities among employees include a range of structural barriers, for example time to participate, production conflicts and shift work [11, 12], as well as aspects like resistance to breaking old habits, a perception that wellness programs are contrary to their work culture (the macho factor) or skepticism about management’s commitment to improve worker’s health [13, 14]. Additionally, many people perceive food intake and their overall health as a personal issue [15, 16]. In order to enhance the possibility of employee participation in worksite promotion activities, it is vital to involve employees in defining the problems and in the planning process to resolve the problems [17, 18]. This is in line with the health promotion concept of World Health Organization, which is based upon several principles, and participation (involvement) is mentioned as one of the most important ones [19]. Employees and others are requested to participate in the development, implementation and evaluation of health promotion programs directly affecting their living and working conditions. The present Food at Work study was conducted as a partnership between the General Workers’ Union in Denmark, mainly organizing unskilled workers, the National Health Agency and a research institute. The aim was to investigate opportunities and impacts of promoting healthy eating in bluecollar worksites both with and without cafeterias. Results indicated that the study was successful in changing self-reported food habits and in decreasing the fat content in cafeteria served meals in the intervention worksites (A. Lassen, S. Fagt, A. V. Thorsen, H. M. Sommer, J. S. Andersen and E. Trolle in preparation). The specific objective of the present paper is to examine factors associated with the outcomes of the study with focus on (i) the number and kind of nutrition-related activities employees being aware of, participating in and at the Department of Nutrition and Department of Epidemiology and Risk Assessment, Danish Institute for Food and Veterinary Research, Soborg, Denmark *Correspondence to: A. Lassen. E-mail: ann@dfvf.dk