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Assilian T, Dehove H, Charreire H, Baudry J, Kesse-Guyot E, Péneau S, Julia C, Gross O, Oppert JM, Bellicha A. Improving student diet and food security in higher education using participatory and co-creation approaches: a systematic review. Int J Behav Nutr Phys Act 2024; 21:71. [PMID: 38978008 PMCID: PMC11232249 DOI: 10.1186/s12966-024-01613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/05/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Higher education students are an important target group for public health nutrition interventions. When designing tailored and contextually relevant interventions, participatory and co-creation approaches are increasingly recognized as promising but their use and effectiveness has not been assessed in this type of population. We systematically reviewed interventions aiming to improve dietary quality and/or food security in higher education settings with the aims 1) to identify and describe their participatory and co-creation approaches and 2) to compare the effectiveness of interventions using or not using participatory and co-creation approaches. METHODS Our search in PubMed, Google Scholar, Web of Science, EMBASE was performed in January 2023 and yielded 3658 unique records, out of which 42 articles (66 interventions) were included. Effectiveness of interventions was assessed at the individual level (longitudinal evaluations) or at the group level (repeated cross-sectional evaluations). A five-level classification was used to describe a continuum of engagement from students and other partners in the intervention design and implementation: no participation (level one), consultation, co-production, co-design and co-creation (levels two to five). To synthetize effectiveness, comparisons were made between studies without participation (level one) or with participation (levels two-five). RESULTS Ten (24%) out of 42 studies used a participatory and co-creation approach (levels two-five). Studies using a participatory and co-creation approach reported a positive finding on individual-level outcome (i.e. overall diet quality or food group intake or food security) in 5/13 (38%) intervention arms (vs 13/31 or 42% for those without participation). Studies using a participatory and co-creation approach reported a positive finding on group-level outcomes (i.e. food choices in campus food outlets) in 4/7 (57%) (vs 8/23 or 35% in those without participation). CONCLUSIONS Participatory and co-creation approaches may improve the effectiveness of nutrition interventions in higher education settings but the level of evidence remains very limited. More research is warranted to identify best co-creation practices when designing, implementing and evaluating nutritional interventions in the higher education setting. TRIAL REGISTRATION PROSPERO registration number CRD42023393004.
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Affiliation(s)
- Tamar Assilian
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
| | - Henri Dehove
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
| | - Hélène Charreire
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
- Univ Paris Est Créteil, LabUrba, Créteil, 94010, France
| | - Julia Baudry
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
| | - Emmanuelle Kesse-Guyot
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
| | - Sandrine Péneau
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
| | - Chantal Julia
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
| | - Olivia Gross
- Health Education and Practices Laboratory, University Sorbonne Paris Nord, Bobigny, 93017, France
| | - Jean-Michel Oppert
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, CRNH-Ile de France, Paris, France
| | - Alice Bellicha
- Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Bobigny, 93017, France.
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Chew HSJ, Rajasegaran NN, Chng S. Effectiveness of interactive technology-assisted interventions on promoting healthy food choices: a scoping review and meta-analysis. Br J Nutr 2023; 130:1250-1259. [PMID: 36693631 DOI: 10.1017/s0007114523000193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Making healthy food choices is crucial for health promotion and disease prevention. While there are an increasing number of technology-assisted interventions to promote healthy food choices, the underlying mechanism by which consumption behaviours and weight status change remains unclear. Our scoping review and meta-analysis of seventeen studies represents 3988 individuals with mean ages ranging from 19·2 to 54·2 years and mean BMI ranging from 24·5 kg/m2 to 35·6 kg/m2. Six main outcomes were identified namely weight, total calories, vegetables, fruits, healthy food, and fats and other food groups including sugar-sweetened beverages, saturated fats, snacks, wholegrains, Na, proteins, fibre, cholesterol, dairy products, carbohydrates, and takeout meals. Technology-assisted interventions were effective for weight loss (g = -0·29; 95 % CI -0·54, -0·04; I2 = 65·7 %, t = -2·83, P = 0·03) but not for promoting healthy food choices. This highlights the complexity in creating effective interactive technology-assisted interventions and understanding its mechanisms of influence and change. We also identified that there needs to be greater application of theory to inform the development of technology-assisted interventions in this area as new and improved interventions are being developed.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nagadarshini Nicole Rajasegaran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Samuel Chng
- Lee Kuan Yew Centre for Innovative Cities, Singapore University of Technology and Design, Singapore, Singapore
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Kershaw JC, Lim TJ, Nolden AA. Health- or Environmental-Focused Text Messages to Increase Consumption of a Sustainable Diet among Young Adults: Importance of Expected Taste. Foods 2023; 12:foods12061297. [PMID: 36981223 PMCID: PMC10048040 DOI: 10.3390/foods12061297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
Taste is a frequently cited barrier to the greater adoption of plant-based foods, a dietary pattern associated with both health and environmental benefits. To examine the role of expected taste in promoting greater adoption of plant-based foods, we examined the impact of a text-message intervention on the expected taste of both meat- and plant-protein foods. Young adults (n = 159) were randomly assigned to receive either health- or environment-focused text messages twice a week for eight weeks. Study measures (pre- and post-) included dietary recalls, the expected tastiness of meat- and plant-protein images and plant-based diets, consumption intention, and person-related factors such as moral satisfaction and the subjective norms of plant-based eating and health and environmental values. Participants rating plant-protein foods tastier at baseline were more likely to report higher actual (p < 0.001) and intended (p = 0.017) consumption of plant proteins following the intervention. While text messages had a limited effect on altering the expected taste of specific plant-protein foods, the messages did elevate the expected tastiness of plant-based diets. Baseline person-related factors positively predicted changes in expected tastiness of plant-based diets. Messages promoting plant-based foods may be more effective if these foods are first perceived as tasty. Furthermore, incorporating person-related considerations into messaging strategies may improve the expected taste of plant-based foods.
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Affiliation(s)
- Jonathan C. Kershaw
- Department of Public and Allied Health, Bowling Green State University, Bowling Green, OH 43403, USA
| | - Tze Joo Lim
- Department of Public and Allied Health, Bowling Green State University, Bowling Green, OH 43403, USA
| | - Alissa A. Nolden
- Department of Food Science, University of Massachusetts Amherst, Amherst, MA 01003, USA
- Correspondence:
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Shatwan IM, Alhefani RS, Bukhari MF, Hanbazazah DA, Srour JK, Surendran S, Aljefree NM, Almoraie NM. Effects of a Smartphone App on Fruit and Vegetable Consumption Among Saudi Adolescents: Randomized Controlled Trial. JMIR Pediatr Parent 2023; 6:e43160. [PMID: 36757770 PMCID: PMC9951076 DOI: 10.2196/43160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/21/2022] [Accepted: 12/25/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Dietary patterns and nutritional status during adolescence have a direct effect on future health outcomes. OBJECTIVE This study aimed to promote fruit and vegetable intake among adolescents using a smartphone app called MyPlate. METHODS This randomized intervention study was conducted in an urban area of Jeddah, Saudi Arabia. We included 104 adolescents aged 13 to 18 years, who were randomized into intervention (n=55) or control (n=49) arms. We examined the effects of MyPlate on fruit and vegetable intake over 6 weeks in the intervention group. Pre- and postintervention questionnaires were used in the intervention and control groups. RESULTS The control group showed a significant increase in fruit consumption scores between baseline (1.15, SD 0.68) and postintervention (1.64, SD 0.98; P=.01), but no significant difference in vegetable consumption scores was observed before (1.44, SD 0.97) and after intervention (1.55, SD 0.90; P=.54). However, there was no significant difference between scores at baseline and after 6 weeks of using the smartphone app for fruit (1.48, SD 0.99 and 1.70, SD 1.11, respectively; P=.31) or vegetables (1.50, SD 0.97 and 1.43, SD 1.03, respectively; P=.30) in the intervention group. Our findings showed no significant impact of using a smartphone app on fruit and vegetable consumption. CONCLUSIONS These findings suggest that a smartphone app did not significantly improve fruit and vegetable intake among adolescents. TRIAL REGISTRATION ClinicalTrials.gov NCT05692765; https://clinicaltrials.gov/ct2/show/NCT05692765.
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Affiliation(s)
- Israa M Shatwan
- Food and Nutrition Department, Human Sciences and Design Faculty, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rabab S Alhefani
- Food and Nutrition Department, Human Sciences and Design Faculty, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mawadah F Bukhari
- Food and Nutrition Department, Human Sciences and Design Faculty, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Danah A Hanbazazah
- Food and Nutrition Department, Human Sciences and Design Faculty, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jumanah K Srour
- Food and Nutrition Department, Human Sciences and Design Faculty, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shelini Surendran
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Najlaa M Aljefree
- Food and Nutrition Department, Human Sciences and Design Faculty, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Noha M Almoraie
- Food and Nutrition Department, Human Sciences and Design Faculty, King Abdulaziz University, Jeddah, Saudi Arabia
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Investigating Web-Based Nutrition Education Interventions for Promoting Sustainable and Healthy Diets in Young Adults: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031691. [PMID: 35162714 PMCID: PMC8835600 DOI: 10.3390/ijerph19031691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/20/2022] [Accepted: 01/29/2022] [Indexed: 12/04/2022]
Abstract
Background: Our current rapidly growing food systems are imposing a heavy burden on both environmental sustainability and human health. Sustainable and healthy diets aim to promote optimal health and have a minimal environmental impact. This study aimed to critically review and synthesise the evidence on the effectiveness of web-based nutrition education interventions aiming to promote sustainable and healthy diets among young adults. Methods: A systematic search of four databases (Medline, PsycINFO, Scopus, and Embase) was conducted in March 2021. Studies were included if they used an online platform to deliver the intervention to young adults and measured at least one aspect of sustainable and healthy diets, such as plant-based food intake, food waste, and local and seasonal produce. Of the 2991 studies, a total of 221 full-text articles were assessed for eligibility of which 22 were included in the final review. Results: A majority of the studies (82%) targeted fruit and vegetable consumption, and close to a quarter of studies (23%) targeted other aspects of a sustainable and healthy diet, such as red meat intake. Only one study included multiple aspects of a sustainable and healthy diet. Program delivery outcomes reported overall positive feedback and engagement. Conclusion: This review suggests that web-based interventions may be effective in promoting some sustainable diet-related outcomes in young adults. However, there is a need for developing and evaluating future programs to promote sustainable diets more comprehensively in order to help young adults make healthy and sustainable food choices.
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Lim TJ, Okine RN, Kershaw JC. Health- or Environment-Focused Text Messages as a Potential Strategy to Increase Plant-Based Eating among Young Adults: An Exploratory Study. Foods 2021; 10:foods10123147. [PMID: 34945698 PMCID: PMC8701197 DOI: 10.3390/foods10123147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Previous plant-based diet (PBD) adoption strategies have primarily focused on health rather than environmental rationale and meat reduction rather than plant-based protein promotion. In this study, we explored the effect of a theory-informed text-message intervention on dietary intentions and behaviors in young adult omnivores and the potential explanatory role of PBD beliefs, subjective norm, self-efficacy, moral norm, and health and environmental values. Participants completed baseline questionnaires and reported dietary intake before being randomly assigned to receive 2–3 health- or environment-focused text messages per week for eight weeks and then repeated baseline assessments. Although we did not see significant changes in meat or plant protein intake, we did observe a marked decrease in intentions to consume animal protein and a marginal increase in fruit and vegetable consumption intention. We identified subjective norms, self-efficacy, and moral satisfaction as the strongest predictors of changes in intention to consume animal or plant protein. Although few group differences were observed, those receiving environment-focused text messages experienced a greater change in values and were more likely to increase vegetable intake. Messages that improve sustainability awareness and provide practical adoption strategies may be part of an effective strategy to influence PBD intake among young adults.
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Affiliation(s)
- Tze Joo Lim
- Department of Public and Allied Health, Bowling Green State University, Bowling Green, OH 43403, USA;
| | - Richard Nii Okine
- Department of Mathematics and Statistics, Bowling Green State University, Bowling Green, OH 43403, USA;
| | - Jonathan C. Kershaw
- Department of Public and Allied Health, Bowling Green State University, Bowling Green, OH 43403, USA;
- Correspondence: ; Tel.: +1-419-372-4579
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Åsberg K, Lundgren O, Henriksson H, Henriksson P, Bendtsen P, Löf M, Bendtsen M. Multiple lifestyle behaviour mHealth intervention targeting Swedish college and university students: protocol for the Buddy randomised factorial trial. BMJ Open 2021. [PMCID: PMC8719203 DOI: 10.1136/bmjopen-2021-051044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Introduction The time during which many attend college or university is an important period for developing health behaviours, with potentially major implications for future health. Therefore, it is concerning that many Swedish students excessively consume alcohol, have unhealthy diets, are not physical active and smoke. The potential of digital interventions which integrate support for change of all of these behaviours is largely unexplored, as are the dismantled effects of the individual components that make up digital lifestyle behaviour interventions. Methods and analysis A factorial randomised trial (six factors with two levels each) will be employed to estimate the effects of the components of a novel mHealth multiple lifestyle intervention on alcohol consumption, diet, physical activity and smoking among Swedish college and university students. A Bayesian group sequential design will be employed to periodically make decisions to continue or stop recruitment, with simulations suggesting that between 1500 and 2500 participants will be required. Multilevel regression models will be used to analyse behavioural outcomes collected at 2 and 4 months postrandomisation. Ethics and dissemination The study was approved by the Swedish Ethical Review Authority on 2020-12-15 (Dnr 2020-05496). The main concern is the opportunity cost if the intervention is found to only have small effects. However, considering the lack of a generally available evidence-based multiple lifestyle behaviour support to university and college students, this risk was deemed acceptable given the potential benefits from the study. Recruitment will begin in March 2021, and it is expected that recruitment will last no more than 24 months. A final data set will, therefore, be available in July 2023, and findings will be reported no later than December 2023. Trial registration number ISRCTN23310640; Pre-results.
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Affiliation(s)
- Katarina Åsberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Oskar Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hanna Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Medical Specialist, Motala Hospital, Motala, Sweden
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Lee KM, Dias GM, Boluk K, Scott S, Chang YS, Williams TE, Kirkpatrick SI. Toward a Healthy and Environmentally Sustainable Campus Food Environment: A Scoping Review of Postsecondary Food Interventions. Adv Nutr 2021; 12:1996-2022. [PMID: 33836531 PMCID: PMC8483956 DOI: 10.1093/advances/nmab026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 12/31/2022] Open
Abstract
Interventions are urgently needed to transform the food system and shift population eating patterns toward those consistent with human health and environmental sustainability. Postsecondary campuses offer a naturalistic setting to trial interventions to improve the health of students and provide insight into interventions that could be scaled up in other settings. However, the current state of the evidence on interventions to support healthy and environmentally sustainable eating within postsecondary settings is not well understood. A scoping review of food- and nutrition-related interventions implemented and evaluated on postsecondary campuses was conducted to determine the extent to which they integrate considerations related to human health and/or environmental sustainability, as well as to synthesize the nature and effectiveness of interventions and to identify knowledge gaps in the literature. MEDLINE (via PubMed), CINAHL, Scopus, and ERIC were searched to identify articles describing naturalistic campus food interventions published in English from January 2015 to December 2019. Data were extracted from 38 peer-reviewed articles, representing 37 unique interventions, and synthesized according to policy domains within the World Cancer Research Foundation's NOURISHING framework. Most interventions were focused on supporting human health, whereas considerations related to environmental sustainability were minimal. Interventions to support human health primarily sought to increase nutrition knowledge or to make complementary shifts in food environments, such as through nutrition labeling at point of purchase. Interventions to support environmental sustainability often focused on reducing food waste and few emphasized consumption patterns with lower environmental impacts. The implementation of integrated approaches considering the complexity and interconnectivity of human and planetary health is needed. Such approaches must go beyond the individual to alter the structural determinants that shape our food system and eating patterns.
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Affiliation(s)
- Kirsten M Lee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Goretty M Dias
- School of Environment, Enterprise and Development, University of Waterloo, Waterloo, Ontario, Canada
| | - Karla Boluk
- Recreation and Leisure Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - Steffanie Scott
- Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | - Yi-Shin Chang
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Tabitha E Williams
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Shimizu R, Rodwin AH, Munson MR. A Systematic Review of Psychosocial Nutrition Interventions for Young Adults. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:316-335. [PMID: 33640278 DOI: 10.1016/j.jneb.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/23/2020] [Accepted: 01/03/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Few have examined the effects of psychosocial nutrition interventions targeting young adults, a population with low fruit and vegetable (FV) consumption. This study investigated the impact of nutrition interventions with psychosocial content on improving young adult FV intake. METHOD This registered systematic review was guided by the Preferred Reported Items for Systematic Reviews and Meta-Analyses. RESULTS Searches on CINAHL, Embase, Medline PubMed, Ovid-Medline, PsychInfo, and Web of Science identified 4,113 records. Twenty-four randomized controlled trials were extracted. Eighteen studies found significant between-group differences in fruit and/or vegetable intake. Young adults with low income and racial-ethnic subgroups were underrepresented. A typology emerged as an organizing framework from the psychosocial intervention content. Interventions were anticipatory, socially engaged, a hybrid (anticipatory and socially engaged), or exposure-based. Studies also reported unintended consequences. DISCUSSION Significant between-group differences were mostly reported by anticipatory, socially engaged, or hybrid interventions, aligning with young adult developmental needs through detailed planning, goal-setting tasks, and/or addressing social norms. Interventions with insignificant differences lacked engagement and adequate exposure. IMPLICATIONS FOR RESEARCH AND PRACTICE Demographically inclusive studies are imperative in addressing dietary disparities by socioeconomic status. A typology of interventions emphasizing content rather than theories or treatment strategies widens opportunities for interdisciplinary collaboration. More research is needed to mitigate unintended consequences (boomerang effects) in which FV intake decreased postintervention or participants disengaged in activities intended to increase FV intake.
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Affiliation(s)
- Rei Shimizu
- Silver School of Social Work, New York University, New York, NY.
| | - Aaron H Rodwin
- Silver School of Social Work, New York University, New York, NY
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Recruiting and retaining young adults: what can we learn from behavioural interventions targeting nutrition, physical activity and/or obesity? A systematic review of the literature. Public Health Nutr 2021; 24:5686-5703. [PMID: 33722332 DOI: 10.1017/s1368980021001129] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe strategies used to recruit and retain young adults in nutrition, physical activity and/or obesity intervention studies, and quantify the success and efficiency of these strategies. DESIGN A systematic review was conducted. The search included six electronic databases to identify randomised controlled trials (RCT) published up to 6 December 2019 that evaluated nutrition, physical activity and/or obesity interventions in young adults (17-35 years). Recruitment was considered successful if the pre-determined sample size goal was met. Retention was considered acceptable if ≥80 % retained for ≤6-month follow-up or ≥70 % for >6-month follow-up. RESULTS From 21 582 manuscripts identified, 107 RCT were included. Universities were the most common recruitment setting used in eighty-four studies (79 %). Less than half (46 %) of the studies provided sufficient information to evaluate whether individual recruitment strategies met sample size goals, with 77 % successfully achieving recruitment targets. Reporting for retention was slightly better with 69 % of studies providing sufficient information to determine whether individual retention strategies achieved adequate retention rates. Of these, 65 % had adequate retention. CONCLUSIONS This review highlights poor reporting of recruitment and retention information across trials. Findings may not be applicable outside a university setting. Guidance on how to improve reporting practices to optimise recruitment and retention strategies within young adults could assist researchers in improving outcomes.
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Islam SMS, George ES, Maddison R. Effectiveness of a mobile phone text messaging intervention on dietary behaviour in patients with type 2 diabetes: a post-hoc analysis of a randomised controlled trial. Mhealth 2021; 7:10. [PMID: 33634193 PMCID: PMC7882278 DOI: 10.21037/mhealth-2020-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/08/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Evidence suggests that mobile phone health (mHealth) programs may improve healthy behaviours and clinical outcomes in patients with type 2 diabetes mellitus (T2DM). However, data on mHealth dietary behaviour is scarce in low-and-middle-income countries. This study aims to determine the effectiveness of a text messaging program on dietary habits in patients with T2DM. METHODS We performed a post-hoc analysis of a randomised controlled trial of text messaging intervention in 236 patients with T2DM recruited from a tertiary hospital. Data were collected on socio-demographics, mobile phone use, family and medical history, self-reported diseases, medication use, health-seeking behaviour, diet and physical activity. Dietary behaviour was assessed using a modified version of WHO STEPS and the Indian Migration Study Food Frequency Questionnaire. Intervention participants received one message/day over six months focusing on lifestyle modification. Dietary intake of fruits, vegetables, sugar beverages and teaspoons of sugar in tea/coffee were determined in serves-per-week and were analysed using Chi-square tests. Poisson regression models, adjusted for age, sex and baseline values following an intention-to-treat approach were performed and expressed as an estimate of effect size. RESULTS At 6 months, the adjusted difference in vegetable consumption was -0.02 serves/week [95% confidence interval (CI): -0.11-0.06, P>0.05] and fruit intake was 0.02 serves/week (95% CI: -0.15-0.21, P>0.05). Consumption of sugar beverages reduced in both groups at 6 months with an adjusted difference of -0.34 serves/week (95% CI: -1.10-0.42, P>0.05). Teaspoons of sugar in tea reduced to 0.1±0.3 teaspoons/week in the control group, however, remained the same at 0.2±0.6 teaspoons/week in the intervention group with an adjusted difference of 0.94 teaspoons/week (95% CI: 0.04-1.84, P<0.05). CONCLUSIONS Our results suggest that a text messaging program did not significantly improve dietary behaviour in patients with T2DM. Further studies are warranted to explore the effectiveness of text messaging on dietary behaviour in adults with T2DM. TRIAL REGISTRATION German Clinical Trials Register DRKS00005188, http://www.drks.de.
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Affiliation(s)
- Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Sharkey T, Whatnall MC, Hutchesson MJ, Haslam RL, Bezzina A, Collins CE, Ashton LM. Effectiveness of gender-targeted versus gender-neutral interventions aimed at improving dietary intake, physical activity and/or overweight/obesity in young adults (aged 17-35 years): a systematic review and meta-analysis. Nutr J 2020; 19:78. [PMID: 32731865 PMCID: PMC7393713 DOI: 10.1186/s12937-020-00594-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/23/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Young adulthood has become synonymous with the development of poor lifestyle behaviours associated with an increased risk of preventable chronic disease in later years. Interventions aiming to improve health behaviours may be more engaging and effective if they are targeted to males or females than interventions with a gender-neutral approach. This review will examine the outcome effectiveness of gender-targeted and gender-neutral interventions targeting nutrition, physical activity or overweight/obesity in young adults (17-35 years). METHODS Six electronic databases were searched for randomised controlled trials (RCTs) published up to December 2019 that evaluated nutrition, physical activity and/or overweight/obesity interventions in young adults (17-35 years). An effective intervention was one where the change in one or more primary outcome was positive and statistically significantly different from baseline, compared with control, or if no control comparator, compared with another active intervention. Effectiveness of outcomes was compared between gender-targeted and gender-neutral studies. RESULTS In total 21,582 manuscripts were identified and 107 RCTs were included; 30 gender-targeted studies (28%) and 77 gender-neutral (72%). Most gender-targeted studies were female targeted (n = 22, 73%). Primary outcome/s were adiposity (n = 36, 34%), nutrition (n = 29, 27%), physical activity (n = 28, 26%), or a combination of (n = 14, 14%). A greater proportion of gender-targeted than gender-neutral studies were effective in improving nutrition (n = 6, 100% and n = 17, 74% of studies respectively) and physical activity outcomes (n = 6, 86% and n = 14, 67% respectively), where as a greater proportion of gender-neutral studies were effective in improving adiposity outcomes (n = 13, 59% and n = 5, 36% respectively). None of these differences were statistically significant. Meta-analyses for weight found no significant differences between gender-targeted and gender-neutral studies for weight loss or weight gain prevention studies. Meta-analysis for fruit and vegetable intake demonstrated a significantly greater increase in intervention participants in gender-targeted studies of +158 g/day for > 3 months. CONCLUSIONS Although differences in outcome effectiveness were identified between gender-targeted and gender-neutral studies, these were not significantly different. This is likely due to an insufficient number of studies to detect a difference. The meta-analysis for fruit and vegetable intake findings should be interpreted with caution due to including only two gender-targeted studies. The findings collectively are suggestive of a potential difference requiring further investigation. To truly determine the effectiveness of gender-targeted interventions, well-designed RCTs comparing gender-targeted interventions with gender-neutral and control are needed. REGISTRATION This systematic review is a secondary analysis of studies included in a systematic review examining the effectiveness of interventions targeting nutrition, physical activity, or overweight/obesity in young adults, for which a predefined protocol was registered with PROSPERO (CRD42017075795).
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Affiliation(s)
- Thomas Sharkey
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
| | - Megan C. Whatnall
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
| | - Melinda J. Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
| | - Rebecca L. Haslam
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
| | - Aaron Bezzina
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
| | - Clare E. Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
| | - Lee M. Ashton
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
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Whitley MD, Payán DD, Flórez KR, Williams MV, Wong EC, Branch CA, Derose KP. Feasibility and acceptability of a mobile messaging program within a church-based healthy living intervention for African Americans and Latinos. Health Informatics J 2019; 26:880-896. [PMID: 31203706 DOI: 10.1177/1460458219853408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Church-based programs can act on multiple levels to improve dietary and physical activity behaviors among African Americans and Latinos. However, the effectiveness of these interventions may be limited due to challenges in reaching all congregants or influencing behavior outside of the church setting. To increase intervention impact, we sent mobile messages (text and email) in English or Spanish to congregants (n = 131) from predominantly African American or Latino churches participating in a multi-level, church-based program. To assess feasibility and acceptability, we collected feedback throughout the 4-month messaging intervention and conducted a process evaluation using the messaging platform. We found that the intervention was feasible to implement and acceptable to a racially ethnically diverse study sample with high obesity and overweight rates. While the process evaluation had some limitations (e.g. low response rate), we conclude that mobile messaging is a promising, feasible addition to church-based programs aiming to improve dietary and physical activity behaviors.
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Feasibility and Preliminary Efficacy of the Eating Advice to Students (EATS) Brief Web-Based Nutrition Intervention for Young Adult University Students: A Pilot Randomized Controlled Trial. Nutrients 2019; 11:nu11040905. [PMID: 31018565 PMCID: PMC6520699 DOI: 10.3390/nu11040905] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 02/08/2023] Open
Abstract
Young adult university students are a priority population for nutrition intervention. This study assessed the feasibility and preliminary efficacy of the EATS (Eating Advice to Students) brief (i.e., single use) web-based nutrition intervention for young adult university students. A 3-month pilot randomized controlled trial (RCT) was conducted with 124 students aged 17–35 from the University of Newcastle, Australia. Participants were randomized to EATS (n = 62) or attention control (n = 62). EATS aimed to improve four target eating behaviors (vegetables, fruit, discretionary foods, breakfast). Primary outcomes were feasibility (recruitment, retention, usage, program acceptability). Recruitment and retention numbers were recorded, the program acceptability was assessed by a process evaluation survey and the website usage was objectively tracked. Preliminary efficacy was assessed via changes in diet quality (primary), fruit, vegetables, discretionary foods and breakfast intake, measured using Food Frequency Questionnaire. Recruitment was completed in five weeks. Retention was 73% (90/124) at 3-months. Intervention participants used EATS 1.5 ± 1.0 times. Satisfaction with EATS was rated at 4.04 ± 0.74 (maximum five). Intervention participants significantly decreased the percentage energy/day from discretionary foods compared with control (−4.8%, 95%CI −8.6, −1.1, p = 0.012, d = −0.34). No significant between-group differences were observed for diet quality, fruit, vegetable or breakfast intakes. EATS demonstrated high feasibility, particularly for reach and acceptability. The university setting and a brief web-based intervention show promise in engaging young adults to improve their eating behaviors.
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Ashton LM, Sharkey T, Whatnall MC, Williams RL, Bezzina A, Aguiar EJ, Collins CE, Hutchesson MJ. Effectiveness of Interventions and Behaviour Change Techniques for Improving Dietary Intake in Young Adults: A Systematic Review and Meta-Analysis of RCTs. Nutrients 2019; 11:nu11040825. [PMID: 30979065 PMCID: PMC6520715 DOI: 10.3390/nu11040825] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022] Open
Abstract
Poor eating habits are common during young adulthood and influence chronic disease morbidity. This systematic review evaluates the effectiveness of interventions aiming to improve dietary intake among young adults and, identifies which behaviour change techniques (BCTs) are most effective. Six electronic databases were searched for RCTs published until October 2018, and evaluating behavioural interventions assessing change in dietary intake in young adults (17–35 years). Of the 18,779 articles identified, 54 were included. Forty studies focused on fruit and/or vegetable intake, of which 63% showed a significant between-group difference in favour of the intervention group. Meta-analysis (n = 17) demonstrated a significant increase in fruit and vegetable intake of +68.6 g/day after three months of intervention and +65.8 g/day for interventions >3 months when compared to control. A meta-analysis (n = 5) on total energy intake found no significant differences between groups. The BCTs with the highest effectiveness ratio were habit formation (100%), salience of consequences (83%) and adding objects to the environment (70%). The review highlights the potential of behavioural interventions to improve young adults’ fruit and vegetable intake but was less convincing for other dietary outcomes. Due to the lack of studies including each BCT, the BCTs imperative to success could not be identified.
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Affiliation(s)
- Lee M Ashton
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia.
| | - Thomas Sharkey
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia.
| | - Megan C Whatnall
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia.
| | - Rebecca L Williams
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia.
| | - Aaron Bezzina
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia.
| | - Elroy J Aguiar
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, MA 01003, USA.
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia.
| | - Melinda J Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
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Heron KE, Romano KA, Braitman AL. Mobile technology use and mHealth text message preferences: an examination of gender, racial, and ethnic differences among emerging adult college students. Mhealth 2019; 5:2. [PMID: 30842950 PMCID: PMC6378243 DOI: 10.21037/mhealth.2019.01.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/15/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions are a potentially feasible way of targeting emerging adult college students' physical and mental health concerns, decreasing health-risk, and augmenting health promoting behaviors. However, there is limited evidence attesting to advantageous ways of designing mHealth treatments in a manner that is apt to be well-received by emerging adult college students at large, and gender, racial, and ethnic subgroups in particular. To address these research gaps, this exploratory study examined general trends, and gender (male, female), racial (White, Black), and ethnic (Latino, non-Latino) differences, in emerging adult college students' mobile technology ownership and phone plan characteristics, technology use behaviors, and mHealth text message preferences. METHODS Participants included 1,371 college students aged 18 to 25 (20.54±1.80) years. Between July 2015 and April 2016, students from three universities in the Mid-Atlantic United States completed an online survey assessing technology use. Descriptive statistics and chi-square tests were run to answer primary study questions. RESULTS Results suggest that students frequently engage with mobile devices and inherent features. Overall, nearly all (99.5%) students owned smartphones, 89.5% had long-term phone contracts, 94.6% had unlimited texting, and 38.6% reported having unlimited data plans. Further, 96.8% reported texting, 92.0% accessing email, 97.3% accessing the internet, and 97.2% using apps on their mobile devices at least once per day. When asked about the types of text messages they would prefer to receive in the context of mHealth interventions, most students preferred messages that did not contain textese, were longer vs. shorter, contained a single vs. multiple exclamation marks, had a smiley face emoticon, used capitalization for emphatic purposes, contained a statement vs. a question, were polite in tone, and were non-directive. There was also multiple gender, racial, and ethnic group differences in mobile device ownership and plan attributes, usage patterns, and text message preferences. CONCLUSIONS The present research provides evidence that smartphones are commonly used by college students and may be a feasible platform for health intervention delivery among diverse student groups. mHealth interventions could use the present results to inform the design of future mHealth interventions and, in turn, increase the acceptability, usability, and efficacy of such treatments for college students at large and diverse student groups in particular.
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Affiliation(s)
- Kristin E. Heron
- Department of Psychology, Old Dominion University, Norfolk, VA 23529, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA 23504, USA
| | - Kelly A. Romano
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA 23504, USA
| | - Abby L. Braitman
- Department of Psychology, Old Dominion University, Norfolk, VA 23529, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA 23504, USA
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The impact of a multilevel childhood obesity prevention intervention on healthful food acquisition, preparation, and fruit and vegetable consumption on African-American adult caregivers. Public Health Nutr 2018; 22:1300-1315. [PMID: 30463637 DOI: 10.1017/s1368980018003038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the secondary impact of a multilevel, child-focused, obesity intervention on food-related behaviours (acquisition, preparation, fruit and vegetable (FV) consumption) on youths' primary caregivers. DESIGN B'More Healthy Communities for Kids (BHCK) group-randomized controlled trial promoted access to healthy foods and food-related behaviours through wholesaler and small store strategies, peer mentor-led nutrition education aimed at youths, and social media and text messaging targeting their adult caregivers. Measures included caregivers' (n 516) self-reported household food acquisition frequency for FV, snacks and grocery items over 30 d, and usual FV consumption in a sub-sample of 226 caregivers via the NCI FV Screener. Hierarchical models assessed average treatment effects (ATE). Treatment-on-the-treated-effect (TTE) analyses evaluated correlation between behavioural change and exposure to BHCK. Exposure scores at post-assessment were based on self-reported viewing of BHCK materials and participating in activities. SETTING Thirty Baltimore City low-income neighbourhoods, USA.ParticipantsAdult caregivers of youths aged 9-15 years. RESULTS Of caregivers, 90·89 % were female; mean age 39·31 (sd 9·31) years. Baseline mean (sd) intake (servings/d) was 1·30 (1·69) fruits and 1·35 (1·05) vegetables. In ATE, no significant intervention effect was found on caregivers' food-related behaviours. In TTE, each point increase in BHCK exposure score (range: 0-6·9) increased caregivers' daily fruit consumption by 0·2 servings (0·24 (se 0·11); 95 % CI 0·04, 0·47). Caregivers reporting greater social media exposure tripled their daily fruit intake (3·16 (se 0·92); 95 % CI 1·33, 4·99) and increased their frequency of unhealthy food purchasing v. baseline. CONCLUSIONS Child-focused community-based nutrition interventions may also benefit family members' fruit intake. Child-focused interventions should involve adult caregivers and intervention effects on family members should be assessed. Future multilevel studies should consider using social media to improve reach and engage caregiver participants.
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