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Behavioural interventions for CVD risk reduction for blue-collar workers: a systematic review
  1. Melissa M Crane1,
  2. Shannon Halloway2,
  3. Zoe L Walts3,
  4. Kara L Gavin4,
  5. Angela Moss2,
  6. Jennifer C Westrick5,
  7. Bradley M Appelhans1
  1. 1 Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA
  2. 2 Department of Community, Systems and Mental Health Nursing, Rush University Medical Center, Chicago, Illinois, USA
  3. 3 Neuroscience Program, Lake Forest College, Lake Forest, Illinois, USA
  4. 4 Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
  5. 5 Library of Rush University Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr Melissa M Crane, Department of Preventive Medicine, Rush University Medical Center, Chicago, USA; Melissa_M_Crane{at}


Objectives Individuals working in blue-collar occupations experience high rates of cardiovascular disease (CVD). The purpose of this systematic review is to describe the characteristics and efficacy of behavioural interventions that have targeted CVD risk factors in this high-risk group.

Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched seven databases to find interventions focused on changing the following: blood pressure, cholesterol, diet, physical activity, smoking or weight. Eligible studies tested a behavioural intervention (not exclusively policy, environmental, or pharmaceutical), in individuals working in blue-collar occupations using a randomised study design. Study quality was evaluated using the National Heart, Lung, and Blood Institute’s study quality assessment tool.

Results 22 studies evaluating 31 interventions were included: 11 were rated as ‘good’ or ‘fair’ quality. Intervention intensity ranged from a single contact via a mailed letter to studies that included individual-level contacts at multiple time points between staff and participants. Studies that included at least some individual contact generally yielded the greatest effects. Interventions had the greatest observed effects on self-report changes in diet, regardless of intervention intensity. Four of the five higher quality studies that explicitly tailored the intervention to the occupational group were successful at reducing at least one risk factor.

Conclusions Interventions that used individual contact and tailored the intervention to the occupational setting yielded the greatest effects on CVD risk-factor reduction in individuals working in blue-collar occupations. Generally, studies were low quality but showed promising effects for reaching this high-risk population. Future work should incorporate these promising findings in higher quality studies.

PROSPERO registration number CRD42019136183.

  • occupational health
  • public health
  • health promotion

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  • Contributors MMC and BMA conceived of the study. JCW performed the search. MMC, SH, ZLW, KLG, AM and BMA participated in screening the titles/abstracts and full-text papers and the selection of relevant studies. MMC and ZLW performed the data extraction and checked the data extraction. MMC, SH, KLG, AM and BMA performed the quality assessment. MMC performed the synthesis and wrote the draft of the paper. All authors contributed to reviewing and revising the paper and read and approved the final manuscript.

  • Funding Research reported in this publication was supported by the of the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number K01DK119457.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.