Diet has been estimated to contribute to approximately 35% of all cancer incidence.'-4 Consistent evidence points to the protective role played by consumption of fruits and vegetables in a large number of epithelial cancers.57 In more than 200 case-control or cohort studies, persons consuming higher amounts of vegetables and fruits or having higher blood levels of carotenoid were less prone to develop various cancers.7 Recent evidence indicates that only 20% to 30% ofAmericans meet recommendations to consume 5 or more servings of fruits and vegetables per day.8'4In response to this discrepancy, the National Cancer Institute launched its 5-aDay for Better Health campaign.15"6 This initiative included 9 research studies targeting both adults and children in a range of settings, one being the worksite. The present study reports the results of the Treatwell 5-aDay study, 1 of 3 worksite-based nutrition intervention studies included in the 5-a-Day for Better Health campaign. This study was designed to assess the effectiveness of a worksite-based nutrition intervention involving families in promoting increased con- Worksites are an increasingly common channel for promoting healthy eating behavior change in large segments of the population.22 Nationally, the proportion of worksites offering nutrition education as part of health promotion programs increased from 17% in 198523 to 32% in 1992.24 However, very few randomized studies have reported the effectiveness of worksite-based nutrition education programs. A recent review reported that only 4 randomized studies assessing the effects of worksite nutrition education programs have been published since 1980, and in only 1 of these studies25 was the worksite the unit of analysis.26 Using the worksite as the unit of analysis is necessary in worksite-based interventions that take advantage of the worksite environment and structures, since individual behavior change is embedded in worksite-level changes.

Integration of occupational health and safety and health promotion may be an essential means of enhancing the effectiveness of worksite tobacco control initiatives with blue-collar workers.

Chronic diseases are the leading cause of death in the United States. Worksites provide a venue to address risk factors and conditions at work through health promotion aimed at improving individual health behaviors, health protection including occupational safety and health interventions, and efforts to support the interface between work and family. In response to the importance of preventing chronic disease at worksites, the National Institutes of Health and the Centers for Disease Control and Prevention convened a workshop to identify research priorities to advance knowledge and implementation of effective strategies to reduce chronic disease risk. Workshop participants outlined a conceptual framework and corresponding research agenda to address chronic disease prevention through integrating health promotion and health protection in the workplace.

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As part of the Harvard Cancer Prevention Program Project, we used a social contextual model of health behavior change to test an intervention targeting multiple risk-related behaviors in working-class, multiethnic populations. We examined the relationships between the social contextual factors in our conceptual model and changes in fruit and vegetable consumption from baseline to completion of intervention in health centers and small business studies. We analyzed change in fruit and vegetable consumption, measured at baseline and final assessments by self-report, in 2 randomized controlled prevention trials: 1 in small businesses (n = 974) and 1 in health centers (n = 1954). Stronger social networks, social norms that were more supportive, food sufficiency, and less household crowding were associated with greater change in fruit and vegetable intake. We also observed differences between our intervention sites. Social context can play an important role in promoting changes in fruit and vegetable consumption.