摘要
目的本研究旨在客观评估城市上班族的午餐营养及生活质量,揭示该人群真实的营养消费需求,并初步探讨上班族的营养干预模式,为合理搭配和选择上班族的营养午餐,以及建立上班族营养健康教育方法提供科学依据。
方法自行设计营养KAP问卷,预调查位于上海市徐汇商业区的公司员工300人,对问卷的信度、效度进行检验。随机抽取位于上海市静安商业区、徐汇商业区和浦东的两个商业区的公司为对象单位,目标公司的企业员工自愿参与正式问卷调查。采用方便取样的方法,于中午就餐时间,在公司内部食堂设立纸面问卷填写点,邀请前来就餐的公司员工参与调查。三日午餐膳食调查由调查员现场面对面询问被调查者第1天的午餐食物摄入情况,然后由被调查者自填第2、3天的午餐情况。午餐现状及满意度问卷、营养知识态度行为问卷、SF-36量表及工作压力自评表由调查对象自填,调查员负责审核回收。建立营养宣传网站www.mylunch.org,并采用举办讲座,发放资料等形式对浦东张江商业区的公司员工进行为期5个月的营养干预,在干预前后分别收集问卷,比较干预效果。
结果上班族的午餐来源最多的是食堂套餐,占总调查人数的29.3%(305/1041)。男性选择自带午饭作为午餐来源的人数只占男性总调查人数的8.3%(40/480),而女性为20.1%(113/561),差异有统计学意义(P<0.05)。男性选择在食堂、休息室和饭店就餐的比例高于女性,选择公司办公室就餐的比例低于女性。调查对象的年龄越大,学历越高,收入越高,选择在食堂就餐的比例越大,而选择自叫外卖的比例越小。调查对象的收入越高,选择食堂点餐和饭店就餐的比例越高。
调查对象的午餐时间在上午11点到下午1点之间的人数最多,占调查总人数的95%(989/1041)。男性调查对象在上午11点前或下午1点后就餐的人数比例为7.5%(36/480),女性的该比例为2.9%(16/561)。调查对象的年龄越大,学历越高,在上午11点到下午1点之间就餐的人数所占比例越高。调查对象的午餐等待时间<10分钟的占总人数的69.1%(719/1041),在10～29分钟的占总人数的20.7%(215/1041)。学历越高的调查对象,其午餐等待时间<10分钟的比例越高,在10～29分钟的比例越低。
调查对象的午餐支出为5-9元的人数最多,占总人数的56%(583/1041)。学历为高中组的调查对象,其午餐支出<10元的人数占该组总人数的74.2%(109/147),高于专科组、本科组及硕士组。
调查对象的可接受午餐价格为5-9元的人数占61.3%(638/1041),10～19元的占34.2%(356/1041)。调查对象的年龄越大,其午餐可接受价格<5元或≥20元人数比例越小。调查对象的收入越高,午餐支出和可接受价格为5-9元的比例越小。调查对象的午餐卫生满意度选择“满意”和“很满意”的人数占调查总人数的30.3%(315/1041),营养满意度为20.8%(217/1041),口味满意度为23.2%(242/1041)。
午餐知识态度行为调查问卷的KMO为0.722,Bartlett's球形检验P<0.01。以特征根>1作为纳入标准,经因子分析,该问卷提取了6个公因子,累计方差贡献率达到54.84%。问卷的内部一致性信度和重测信度均大于0.7,信度较好。调查对象的营养知识评分为一般及以下的占48.2%(357/740),营养态度评分为良好及以上的占93.1%(689/740)。女性调查对象的营养知识、态度、行为的平均得分高于男性(P<0.05)。30～49岁调查对象的营养知识、行为问卷的平均得分高于20-29岁调查对象的得分(P<0.05)。硕士组调查对象的营养知识、行为的平均得分最高。
调查对象的午餐禽畜肉平均摄入量为(59.44±40.29)g,符合推荐摄入量的人数占6%(27/903),超过推荐量的占78.8%(712/903)。除禽畜肉外,调查对象的其他食物摄入量低于推荐量的人数均占半数以上,尤其是乳制品、薯类及杂粮和豆制品。女性水果和乳制品的平均摄入量高于男性,但粮谷类和肉类的平均摄入量低于男性。40～49岁调查对象的蔬菜、豆制品平均摄入量高于20～29岁及30～39岁调查对象,但水果、乳制品的平均摄入量低于后两者。硕士组调查对象的水果和乳制品的平均摄入量高于学历较低的其他三组,而蛋类的平均摄入量低于其他三组。以上差异均有统计学意义(P<0.05)。
调查对象午餐的膳食纤维、维生素A、维生素B1、维生素B2、维生素C、钙、镁、铜摄入明显不足,摄入量低于EAR或者80%AI的人数比例占60%以上,而午餐碳水化合物、钾、锌、硒摄入量低于EAR或者80%AI的人数比例占50%以上,与之相反,胆固醇和脂肪摄入过量的人数均占50%以上。女性午餐铁摄入量低于80%AI的人数比例是65.6%,高于男性(14.4%)。
除了能量、蛋白质、硫胺素、锌以外,有18种营养素的摄入量与午餐营养指数得分呈显著性相关。调查对象午餐胆固醇摄入量>180g的人数占46.3%(418/903)。男性调查对象的午餐营养指数的平均得分低于女性,差异有统计学意义(P<0.05)。20-29岁组和40～49岁组调查对象的午餐营养指数得分均低于30～39岁组。高中组、专科组和本科组的午餐营养指数得分均低于硕士组的平均得分,差异有统计学意义(P<0.05)。不同收入调查对象的午餐营养指数得分无统计学差异。
干预后,张江商业区调查对象的营养知识、态度和行为的平均得分均有明显提高,差异有统计学意义(P<0.05)。调查对象午餐水果和膳食纤维的平均摄入量增加,差异有统计学意义(P<0.05)。干预前调查对象的午餐食物脂肪量为(15.54±11.34)g,干预后有所减少。
男性调查对象的躯体功能和肌体疼痛的得分高于女性。(20～29)岁调查对象的情感角色平均得分低于高年龄两组,(40～49)岁调查对象心理健康平均得分高于低年龄两组,差异有统计学意义(P<0.05)。除躯体功能和躯体角色外,高中组调查对象的各维度得分均高于其他三组,差异均有统计学意义(P<0.05)。调查对象的压力应对完美的人数占总调查人数的25.9%(205/791),压力良好的占71.9%(569/791),遇到压力问题需要好好解决的只占2.1%(17/791)。男性调查对象的压力自评表平均得分为(41.73±14.47)分,高于女性的平均得分,差异有统计学意义(P<0.05)。
Spearman相关分析结果表明,心理健康得分(MCS)与身体健康得分(PCS)呈正相关,相关系数为0.656。PCS和MCS与工作压力均呈负相关,相关系数分别为-0.302、-0.309。PCS和MCS与营养KAP均呈正相关,相关系数分别为0.132、0.141。营养KAP与午餐营养指数存在正相关关系,相关系数为0.170。
结论1.上班族午餐来源多样,女性调查对象自带午饭的比例高于男性,就餐地点主要在食堂和办公室,就餐时间较规律。午餐支出与可接受价格有差异,希望价格在5～9元的调查对象比例较高。上班族的午餐卫生营养口味满意度均较差,食堂和自带午饭的满意度较高,自叫外卖的满意度较差。2.上班族午餐的薯类及杂粮,豆制品摄入过少,蔬菜水果摄入明显不足,动物性食物摄入过多。3.上班族营养知识不足,女性营养知识态度行为比男性好。年龄、学历、收入对营养知识和行为影响明显,但对营养态度影响较小。4.干预对上班族的营养知识、营养态度和营养行为有改善作用。5.上班族身体健康状态良好,工作压力自评良好,40～49岁上班族的心理健康表现比年龄较低的上班族好。6.上班族的营养知识对午餐营养有促进作用,营养知识态度行为可能与生活质量有关。
Objective To evaluate lunch nutrition status and life quality of office workers, discover the true nutritional needs, and provide the scientific basis to reasonable food choice of lunch.
Methods Questionnaire of nutritional KAP was self-designed.300 office workers in Xuhui District were pre-surveyed to test the reliability and validity of the questionnaire. Target companis' employees voluntarily participated in the formal survey. Office workers whose companies were random sampled from four commercial districts in Shanghai were invited to finish the questionnaire in the the company dining hall after lunch. For the 3 days lunch Questionnaire, the first day's lunch was investigated by investigators face to face, but intakes on the other two days were recorded by the workers themselves. Lunch Status and Satisfaction Questionnaire, Nutrition KAP Questionnaire, SF-36 Scale and Work Stress Questionnaire were also finished by the workers themselves. The investigators were responsible for reviewing and withdrawing the questionnaires. The brochures about nutrition knowledge were delivered in target companies in Zhangjiang commercial district, Pudong District as intervention during 5 months. As the same time, the website www.mylunch.org was set up and seminars were held in these companies. Surveys were conducted before and after the intervention.
Results 29.3% of office workers chose company dining hall having their lunch, and it was the most preferred lunch source.20.1% of women workers brought their own lunch to companies, while 8.3% of men workers did this way (P<0.05). The proportion of men workers chose company dining hall, company lounge and restaurants as lunch place were higher than women, however the proportion in office were lower than women. The proportion of elder workers having lunch in company dining hall was higher than the younger, as well as the workers with higher education degree and income. Compared with the other workers, office workers with higher income preferred to have lunch in company dining hall and restaurant.
95% of office workers had lunch between 11am and lpm, and men was more than women (P<0.05). The proportion of workers having lunch at this time increased with age and education degree.69.1% of workers waited less than 10 minutes for lunch, and 20.7% waited between 10 and 29 minutes. There was higher proportion with higher education degree in<10 minutes group, and lower proportion in 10～29 minutes group.56% of office workers'daily lunch expenditure was 5～9 RMB, and 36.4% was 10～19 RMB. The proportion of workers whose education degree was high school or below choosing less than 10 RMB as daily lunch expenditure was 74.2%, and this proportion was much higher than that of other education degree groups.61.3% of office workers chose 5～9 RMB as accepted lunch price, and 34.2% chose 10～19 RMB. The proportion of workers choosing 5～9 RMB as accepted lunch price decreased with age and income.30.3% of office workers felt satisfy or very satisfy with lunch hygiene status,20.8% with lunch nutrition and 23.2% with taste.
The KMO of the Nutrition KAP Questionnaire was 0.722, and Bartlett's test of sphericity was P<0.01. By factor analysis, six factors were extracted when the eigenvalue>1 was defined as the inclusion criteria. The questionnaire's cumulative variance contribution rate reached 54.84%. The questionnaire's internal consistency reliability and test-retest reliability were greater than 0.7. In 48.2% (357/740) of office workers, the score of nutrition knowledge was defined as fair or poor.93.1% (689/740) of office workers'score of nutrition attitude was defined as good or very good. The women had a higher average score than men in knowledge, attitude and practice (P<0.05). The workers aged from 30 to 49 years old had a higher average score than those aged from 20 to 29 in knowledge and practice (P<0.05). Those with master degree or the average disposable income more than 5000 RMB had the highest score than others in nutrition knowledge and practice.
The average intake of meat was (59.44±40.29) g. 6% of workers were meet the recommended amount, and 78.8% were excessive. Except meat, the intakes of other kind of food were few, especially dairy product, potatoes, whole grains and soy products. More than half of office workers whose food intake was less than the recommended amount. Women workers had more fruit and dairy product, while less grains and meat than men. The average vegetables intake and soy products intake in office workers aged from 40 to 49 years old were more than younger workers, while fruits intake and dairy products intake were less than the younger ones. Office workers whose education degree were master or above had more fruits and dairy products intake, however, the average egg intake were less than the other groups. Above differences were statistically significant (P<0.05). The intakes of dietary fiber, Vitamin A, Vitamin B1, Vitamin B2, Vitamin C, calcium, magnesium and copper were not enough. The proportion of office workers whose intake of these nutrients was less than EAR or 80% of AI accounted for more than 60%. More than half of the workers had excessive cholesterol and fat intake compared recommended amount. The proportion of women workers whose iron intake was less than 80% of AI was 65.6%, while the proportion of men was 14.4%.
Except energy, protein, Vitamin B2 and Zinc,18 kinds of nutrients correlated with lunch nutrition index, and the correlation coefficients were between 0.068 and 0.404. Energy, fat, cholesterol, niacin, sodium and selenium intake were negatively correlated with lunch nutrition index. The means of index of lunch nutrition for men was lower than women (P<0.05). Among the different education groups and age groups, the means of index of lunch nutrition was the highest in master group and aged 30 to 39 group. After the intervention, the average scores of nutrition knowledge, attitude and practice were increased (P<0.05). The average fruits intake and dietary fiber intake were increased too (P<0.05). The average food fat was decreased.
The average scores of physical functioning and bodily pain in men were higher than women. Office workers aged from 20 to 29 had lowest average role-emotional score than the elder two groups, and the workers aged from 40 to 49 had the highest mental health score than the younger two groups (P<0.05). The scores of office workers whose education degree was high school or below were highest than the other three groups except in physical functioning and role-physical(P <0.05).25.9% of workers coped with working pressure perfectly,71.9% response well and 2.1% having problem.
The results of Spearman correlation analysis suggested mental composition score (MCS) positively correlated with physical composition score (PCS) and the coefficient was 0.656. PCS and MCS correlated with nutrition KAP, and the coefficient were 0.132 and 0.141 respectively. PCS and MCS negatively correlated with working pressure, and the coefficient were -0.302 and-0.309 respectively. Nutrition KAP correlated with lunch nutrition index, and the coefficient was 0.170.
Conclusion 1 The proportion of women workers bringing their own lunch to companies was higher than men. Actual lunch expenditure was different from acceptable price. The satisfaction with lunch hygiene, nutrition and taste was poor.2 The intakes of potatoes, whole-grain and soy product were not few, and dietary fiber, Vitamin A, Vitamin B1, Vitamin B2, Vitamin C and calcium were less than the recommended amounts. The intake of cholesterol and fat was excessive.3 Office workers'attitude and practice for nutrition were correct in some field, however the knowledge was inadequate. Sex, age, education and income had significant effect on the knowledge and practice, but the effect on attitude wasn't found.4 The intervention could improve nutrition knowledge, attitude and practice for office workers.5 The physical health of office workers was good and they coped with working pressure well. Office workers aged from 40 to 49 had better mental health than the younger ones.6 The nutrition knowledge might improve lunch nutrition. The nutrition knowledge, attitude and practice might correlate with quality of life.
引文
[1]马冠生,胡小琪,栾德春,等.中国居民的就餐行为[J].营养学报,2005,27(4)：272-275
[2]搜狐健康,上班族午餐完全手册.http://health.sohu.com/s2006/bailingwucan/
[3]French SA, Story M, Neumark-Sztainer D, Fulkerson JA, Hannan P. Fast food restaurant use among adolescents:associations with nutrient intake, food choices and behavioral and psychosocial variables. Int J Obes 2001;25:1823-33.
[4]Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast-food consumption on energy intake and diet quality among childrenin a national household survey. Pediatrics 2004; 113:112-8.
[5]Pereira MA, Kartashov AI, Ebbeling CB, et al. Fast-food habits, weight gain,and insulin resistance (the CARDIA study):15-year prospective analysis.Lancet 2005;365:36-42.
[6]李立明,饶克勤,孔灵芝.中国居民2002年营养与健康状况调查[J]_中华流行病学杂志,2005,26(7)：478-484.
[7]马晓.健康教育学[M].北京：人民卫生出版社,2004：58-61.
[8]文国新,美黑丽,赵俊岭.浅谈KAP理论与自愿无偿献血招募.中国输血杂志,2005,18(5)： 438-439.
[9]Baicker, K., Cutler, D., Song, Z., Workplace wellness programs can generate savings. Health Aff.2010; 29,1-8.
[10]Williams C., Poulter J. (1991) Formative evaluation of a workplace menu labelling scheme. Journal of Human Nutrition and Dietetics 4:251-62.
[11]Campbell, M., Tessaro, I., DeVellis, B., et al. (2002) Effects of a tailored health promotion program for female blue-collar workers:health works for women. Preventive Medicine 34: 313-23.
[12]Balfour, D., Moody, R., Wise, A., et al. (1996) Food choice in response to computer-generated nutrition information provided about meal selections in workplace restaurants. Journal of Human Nutrition and Dietetics 9:231-7.
[13]Lassen, A., Vibeke Thorsen, A., Trolle, E., et al. (2004) Successful strategies to increase the consumption of fruits and vegetables:results from the Danish '6 a day' Worksite-Canteen Model Study. Public Health Nutrition 7(2):263-70.
[14]Sarah L, Booth Ph.D, James F. Environmental and Societal Factors Affect Food Choice and Physical Activity:Rationale, Influences, and Leverage Points[J]. Nutrition Reviews.2001, 59 (3):21-36.
[15]Tinker, L.F., Perri, M.G., Patterson, D.J. The effects of physical and emotional status on adherence to a low-fat dietary pattern in the women's Health Initiative [J]. Am. Diet. Assoc. 2002,102,6789-6794.
[16]R.A. Hobday, S. Thomas, A. O'Donovan. Dietary intervention in chronic fatigue syndrome [J]. The British Dietetic Association Ltd 2008 J Hum Nutr Diet,2008,21:141-149
[17]Bandura A, Self-efficacy mechanism in human agency[J]. Am Psychol.1982,37:122-147.
[18]Bandura A. Mediating Processes. In:Bandura A, ed. Self-efficacy:The exercise of control. New York:W.H.Freeman and Co,1997:116-161.
[19]冯立天主编.中国人口生活质量研究[M].北京.北京经济学院出版社.1992.4,64-65.
[20]Van Horn L, Dolecek TA, Grandits GA, Adherence to dietary recommendations in the special intervention group in the Multiple Risk Factor Intervention Trial. Am J Clin Nutr [J],1997,65 (supp):289S-304S.
[21]方积乾,孙振球.卫生统计学第5版[M].人民卫生出版社.2004.11：289.
[22]朱远程,马栋.谈结构方程模型的应用策略[J].企业管理.2010,6：73-74.
[23]Guenther, P.M., Reedy, J., Krebs-Smith, (2007). Development and Evaluation of the Healthy Eating Index-2005:Technical Report. Center for Nutrition Policy and Promotion, U.S. Department of Agriculture.
[24]王憓,周标,张爽爽.杭州市社区老年人生存质量现状及其影响因素研究[J],中华预防医学杂志,2009,43(8)：739-742.
[25]Janice Boyce, Charles C. Broz, Margaret Binkley. Consumer perspectives:take-out packaging and food safety [J]. British Food Journal.2008,110 (8):819-828.
[26]中国营养学会编著.中国居民膳食指南(2007)[M].拉萨：西藏人民出版社.2007,12：80.
[27]谷贻光,宋新娜,李永华.两种膳食调查方法估计膳食类胡萝1素摄入量的比较[J].中国食物与营养.2010(5)：78-80.
[28]赵水平.血脂第5讲血脂异常与冠心病[J].中国临床医生.2004,32(1)：23.
[29]刘青萍,王刚.超声检测颈动脉与血脂三联关系的探讨[J].中华现代影像学杂志.2004,1(2)：148-149.
[30]唐玉平,李鹏高,刘静.社区医生的膳食合理性调查[J].中华实用医药杂志,2004,4(6)：45-47.
[31]马晓菊.成都市大学生膳食状况、营养KAP与体质调查[D].四川：四川大学,2006.
[32]孙振球.医学统计学[M].第2版.北京：人民卫生出版社,2005：756-769.
[33]赵晖,陈家旭.“亚健康状态中医证候调查问卷”的信度和效度评价[J].中华中医药杂志,2011,26(1)：61-65.
[34]刘宁,高尔生,武俊青.居民营养知识、态度、行为及影响因素分析[J].中国公共卫生,2008,24(4)：482-485.
[35]那立欣,刘衷芳,赵丹.哈尔滨市居民营养知识及行为调查[J].中国公共卫生2009,25(3)：383-384.
[36]林宇涛,郭红卫,邓志豪.健康饮食指数评价澳门2型糖尿病患者膳食质量[J].卫生研究.2004,33(6)：737-740.
[37]解瑞宁,庞道华,张孝霞.护理专业学生营养教育效果分析[J].中国校医,2008,22(1)：57-58.
[38]王少康,池红,胡永桢.南京市中小学生营养知识健康教育效果评价[J].中国学校卫生,2008,29(7)：588-589
[39]周鹏,孙健平,沈莉.上海市长宁新华社区居民营养知识、态度、行为调查[J].2005,9(6)：642-643.
[40]Jill A. Metz, PhD; Judith S. Stern, ScD, RD; Penny Kris-Etherton, PhD A Randomized Trial of Improved Weight Loss With a Prepared Meal Plan in Overweight and Obese Patients[J]. Arch Intern Med.2000,160:2150-2158.
[41]Vairyam JN, Blaylock J, Smallwood D, Basiotis PP. USDA's Healthy Eating Index and Nutrition Information.1998. U.S. Department of Agriculture, Economic Research Service, Food and Rural Economics Division. Technical Bulletin No.1866.iv, p18.
[42]刘祖阳.营养干预方法与策略[J].现代预防医学.2007,1682-1683.
[43]Basiotis PP, Carlson A, Gerrior SA, et al. The Healthy Eating Index:1999-2000. US Department of Agriculture, Center for Nutrition Policy and Promotion.2002, CNPP-12.
[44]王健,马军.健康教育[M].北京：高等教育出版社,2004：160-161.
[45]风笑天.生活质量研究：近三十年回顾及相关问题探讨[J].社会科学研究,2007,6：1-8.
[46]李鲁,王红妹,沈毅.SF-36健康调查量表中文版的研制及其性能测试[J].中华预防医学杂志,2002,36(2)：109-113.
[47]刘朝阳,李宁秀,任晓晖,等.36条简明量表在中国人群中的适用性研究[J].华西医大学报,2001,32(1)：39-42.
[48]姜巍.健康与亚健康的概念[J].社区医学杂志.2006,4(6)：62-63.
[49]郭超,张三保.企业应注重员工的情绪管理[J]_中国发展观察,2008,2：46.
[50]周梅,李健,邵伟民,等.昆明市21家厂矿企业职业人群健康现状调查[J].职业与健康,2009,25(15)：1592-1594.
[51]Frankenhaeuser, Marianne; Johansson, Gunn. Stress at work:Psychobiological and psychosocial aspects [J]. Applied Psychology,1986,35 (3):287-299.
[52]石林.工作压力的研究现状与方向[J].心理科学,2003,26(3)：494-497.
[53]蒲德祥,杨卫星,冯学银.企业员工工作压力相关因素研究[J].2004,24(1)：51-53.
[54]Holger J Schunemann, Francesca Sperati, Maddalena Barba. An instrument to assess quality of life in relation to nutrition:item generation, item reduction and initial validation[J]. Health and quality of life outcomes,2010,8:26.
[55]Wright L, Hickson M, Frost G Eating together is important:using a dining room in an acute elderly medical ward increase energy intake. Journal of Human Nutrition & Dietetics,2006, 19(1):23-26.
[56]JUDITH T. BARR, ScD, GERALD E. The need for a nutrition-related quality-of-life measure [J]. J Am Diet Assoc 2003,103(2):177-80.
[1]刘祖阳.营养干预方法与策略.现代预防医学,2007；34(9)：1682-1683
[2]Tina B. Sahay, MHSc et al. Effective Components for Nutrition Interventions:A Review and Application of the Literature. Health Promotion Practice.2006; 7(4):418-427.
[3]杨正雄,赵文华,陈君石.饮食行为干预的研究进展[J].2008；29(6)：573-575.
[4]Anne V Thorsen, Anne D Lassen, Inge Tetens, Long-term sustainability of a worksite canteen intervention of serving more fruit and vegetables [J]. Public Health Nutrition:13 (10): 1647-1652.
[5]Simone A, Lisa J, Harnack. Worksite environment intervention to prevention to prevent obesity among metropolitan transit workers[J]. Prevention Medicine 2010 (50):180-185.
[6]Beresford SAA. Worksite study promoting activity and changes in eating(PACE):Design and baseline results, Obesity Rev,2007; 15:4-15
[7]Aldana SG, Greenlaw RL et al. The effects of a worksite chronic disease prevention program, Journal of occupational and environmental medicine,47(6):558-564
[8]Thorogood M. A systematic review of population and community dietary intervention to prevent cancer, Nutrition research reviews,2007;20(1):74-88
[9]吴熹,许兵.高血压病患者的社区健康教育[J].护理学杂志,2001,16(7)：438-440.
[10]Plotnikoff RC, McCargar LJ et al. Efficacy of an e-mail intervention for the promotion of physical activity and nutrition behavior in the workplace context, American Journal of Health Promotion,2005; 19(6):422-429.
[11]Anke Oenema, Johannes Brug, Arie Dijkstra. Efficacy and use of an Internet-delivered computer-tailored lifestyle intervention, Targeting saturated fat intake, physical activity and smoking cessation:a randomized controlled trial [J]. Annals of behavioral medicine,2008; 35(2):125-135.
[12]Amanda Philyaw Perez, Martha M. Phillips, Carol E. Cornell, Promoting dietary change among state health employees in Arkansas through a worksite wellness program:The Healthy Employee Lifestyle Program (HELP) [J]. Prev Chronic Dis 2009; 6(4):1-8.
[13]Barbara Sternfeld, Clifford Block, Charles P. Improving diet and physical activity with ALIVE (a worksite randomized trial)[J].2009; 36 (6):475-483.
[14]Maes L, Vereecken CA et al. A feasibility study of using a diet optimization approach in a web-based computer-tailoring intervention for adolescents, International journal of obesity, 2008; 32(5):76-81.
[15]Susan B. Racette, Susan S. Deusinger, Cindi L Inman, Worksite Opportunities for Wellness (WOW):Effects of cardiovascular disease risk factors after 1 year[J]. Preventive Medicine, 2009; 49:108-114.
[16]Pierce JP, Newman VA, Natarajan L et al. Telephone counseling helps maintain long-term adherence to a high-vegetable dietary pattern. [J] J Nutr,2007;137(10):2291-2296
[17]杜文雯.营养教育效果评价的理论基础及其相关应用研究进展.国外医学卫生学分册,2007：34(2)：110-116
[18]马晓.健康教育学[M].北京：人民卫生出版社,2004：58-61.
[19]文国新,美黑丽,赵俊岭.浅谈KAP理论与自愿无偿献血招募.中国输血杂志,2005,18(5)：438-439.
[20]Sorensen G, Stoddard A, Peterson K, Cohen N, Hunt MK, Stein E et al. Increasing fruit and vegetable consumption through worksites and families in the Treatwell 5-a-Day study. American Journal of Public Health,89(1),54-60
[21]Sorensen G, Thompson B, Glanz K et al. Work site-based cancer prevention:primary results from the Working Well Trial. American Journal of Public Health,86(7),939-947.
[22]瞿成凯,张静,瞿玉明.复合式与单纯式营养干预效果的初步比较[J].卫生研究,2004；33(6)：719-721.
[23]Williams C., Poulter J. (1991) Formative evaluation of a workplace menu labelling scheme. Journal of Human Nutrition and Dietetics 4:251-262.
[24]Campbell, M., Tessaro, I., DeVellis, B., et al. (2002) Effects of a tailored health promotion program for female blue-collar workers:health works for women. Preventive Medicine 34: 313-323.
[25]Balfour, D., Moody, R., Wise, A., et al. (1996) Food choice in response to computer-generated nutrition information provided about meal selections in workplace restaurants. Journal of Human Nutrition and Dietetics 9:231-237.
[26]Lassen, A., Vibeke Thorsen, A., Trolle, E., et al. Successful strategies to increase the consumption of fruits and vegetables:results from the Danish '6 a day' Worksite-Canteen Model Study. Public Health Nutrition,2004; 7(2):263-270.
[27]Laurie M, Anderson, Toby A. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity [J], Am J Prev Med 2009; 37(4):340-357.