Designing effective nutrition interventions for adolescents

Determinants of Diet Quality in Adolescents: Results from the Prospective Population-Based EVA-Tyrol and EVA4YOU Cohorts

(1) Background: Unhealthy dietary behaviors are estimated to be one of the leading causes of death globally and are often shaped at a young age. Here, we investigated adolescent diet quality and its predictors, including nutrition knowledge, in two large Central European cohorts. (2) Methods: In 3056 participants of the EVA-Tyrol and EVA4YOU prospective population-based cohort studies aged 14 to 19 years, diet quality was assessed using the AHEI-2010 and DASH scores, and nutrition knowledge was assessed using the questionnaire from Turconi et al. Associations were examined utilizing multivariable linear regression. (3) Results: The mean overall AHEI-2010 score was 42%, and the DASH score was 45%. Female participants (60.6%) had a significantly higher diet quality according to the AHEI-2010 and DASH score. AHEI-2010 and DASH scores were significantly associated (p < 0.001) with sex, school type, smoking, and total daily energy intake. The DASH score was additionally significantly associated (p < 0.001) with age, socioeconomic status, and physical activity. Participants with better nutrition knowledge were more likely to be older, to attend a general high school, to live in a high-income household, to be non-smokers, and to have a higher diet quality according to the AHEI-2010 and DASH score. (4) Conclusions: Predictors of better diet quality included female sex, physical activity, educational level, and nutrition knowledge. These results may aid focused interventions to improve diet quality in adolescents.

A systematic review exploring evidence for adolescent understanding of concepts related to the developmental origins of health and disease

The developmental origins of health and disease (DOHaD) framework has highlighted the importance of the early life period on disease risk in later life with impacts that can span generations. A primary focus to date has been around maternal health and the 'First Thousand Days' as a key developmental window whereby an adverse environment can have lasting impacts on both mother and offspring. More recently, the impact of paternal health has gathered increasing traction as a key window for early life developmental programming. However, to date, adolescents, the next generation of parents, have attracted less attention as a key DOHaD window although many behavioural traits become entrained during adolescence and track into adulthood. This systematic review examined literature focused on identifying adolescent understanding of DOHaD concepts. Consistent across the eligible articles was that overall understanding of DOHaD-related concepts in adolescents was low. Three key themes emerged: 1. Individual-level awareness of DOHaD concepts (cognitive engagement and action of the adolescents themselves); 2. Interpersonal communication and social awareness of DOHaD concepts (cognitive engagement and communication of the DOHaD concepts to family and wider community); and 3. Health literacy and the promotion of adolescence as a key DOHaD life stage. These findings highlight the need to develop strategic approaches to increase DOHaD awareness that are not only appealing to adolescents but can also support sustained changes in health behaviour. Investment in today's adolescents has the potential to act as a NCD 'circuit breaker' and thus will yield significant dividends for future generations.

The "Planning Health in School" Programme (PHS-pro) to Improve Healthy Eating and Physical Activity: Design, Methodology, and Process Evaluation

Few interventions have successfully promoted healthy eating and active living among children with effective changes in anthropometric health outcomes. Well-designed interventions involving multiple strategies to convert the knowledge already available into action are needed for preventing childhood obesity. In this study, an educational programme called "Planning Health in School" (PHS-pro) was designed, implemented and evaluated to contribute to the prevention of obesity in childhood. The PHS-pro aimed at improving the eating behaviours and lifestyles of Portuguese grade-6 children towards healthier nutritional status. This paper describes and evaluates the PHS-pro concerning: (i) the research design within the theoretical framework grounded on "The Transtheoretical Model" and the stages of change; (ii) the educational components and the application of the participatory methodology to engage children to meet their needs, as active participants in their change process; and (iii) the process evaluation of the intervention. The implementation of the PHS-pro took into account the views and inputs of the participants for evaluating the educational components that should be considered in the designing of interventions aiming to be effective strategies. From the health promotion perspective, this study is important because it examines new approaches and pathways to effectively prevent overweight and obesity in children.

Effects of computer-based interventions on food consumption and anthropometric parameters of adolescents: A systematic review and metanalysis

This review aimed to systematically assess the effects of computer-based interventions for the promotion of healthy eating on anthropometric indicators and food consumption of adolescents at school. Relevant scientific articles were searched in MEDLINE/PubMed, Embase, Scopus, Lilacs, PsycINFO and Cochrane Library/CENTRAL following the recommendations by PRISMA guide in August 2021. The quality and risk of bias in the studies were assessed by two reviewers independently. The search strategy retained 13 studies for qualitative analysis. In total 9.603 adolescents of both sexes, were recruited in a school environment. According to studies with information for the meta-analysis, a reduction in the average consumption of fats in favor of computer-based intervention was identified (SMD: -0.14; 95% CI -0.24;-0.05). Considering the changes in the consumption of fruits and vegetables (SMD: 0.09; 95% CI -0.08; 0.26) and in the BMI (WMD: -0.02; 95% CI -0.18; 0.14), the analyses did not identify the effect of computer-based interventions on these parameters after follow-up. The results of this review demonstrate that there is evidence of the positive effect of using digital technology (website and CD-ROM) in educational programs with a focus on promoting a healthy lifestyle, with evidence on reducing fat consumption.

Factors That Influence Snacking Behaviors of Adolescents From Urban Communities: A Qualitative Study

OBJECTIVE

To qualitatively explore factors that influence snacking behaviors of adolescents from urban communities.

DESIGN

One-time, semistructured phone interviews based on Social Cognitive Theory.

SETTING

Boys and Girls Club in New York City.

PARTICIPANTS

A total of 30 adolescents (aged 12-18 years; mean age 15.2 years, mostly female [57%], and Black or African American [83%]) were purposively recruited. This sample is representative of adolescent members at this Boys and Girls Club in New York City.

PHENOMENON OF INTEREST

Adolescents were asked about personal, environmental, and behavioral factors influencing snacking.

ANALYSIS

Interviews were audio-recorded, transcribed, and transcripts were analyzed using the thematic analysis approach in NVivo (version 12).

RESULTS

In terms of personal factors, adolescents' snacking was influenced by preference (eg, taste and brand), health benefits, and health concerns. Regarding the social environment, adolescents remarked that snacking with peers promoted unhealthy snacking, while snacking, with family promoted healthier snacking. The family culture was also a salient factor. In addition, adolescents discussed how proximity to corner stores in their physical environment fostered unhealthy snacking. Finally, behavioral factors that influenced frequent snacking were high self-efficacy and food autonomy.

CONCLUSIONS AND IMPLICATIONS

Snacking among adolescents from urban communities is influenced by preference, health, family/peer influence, neighborhood availability/access, and high autonomy. These factors can be targeted in interventions to improve snacking among this demographic.

Effect Evaluation of Sahtak bi Sahnak, a Lebanese Secondary School-Based Nutrition Intervention: A Cluster Randomised Trial

Objective

To evaluate the effectiveness of Sahtak bi Sahnak on dietary knowledge and adherence to dietary guidelines in Lebanese adolescents.

Design/setting

A cluster randomised controlled trial was conducted in public and private secondary schools located in urban and rural regions in Lebanon.

Participants

Sixteen secondary schools including 1,572 adolescents were randomly assigned to the intervention (n = 739) or control group (n = 833).

Intervention

Sahtak bi Sahnak is an educational school-based intervention dedicated to improving dietary adherence to nutritional guidelines, increasing the level of dietary knowledge, and preventing the development of obesity during adolescence. It was systematically designed based on the Intervention Mapping framework. The total length of the intervention was around seven educational sessions, until all of the 11 lessons were covered. Each education session lasted 20-40 min.

Main Outcome Measures

Dietary knowledge and adherence levels were measured at baseline and post-intervention using validated questionnaires.

Statistical Analysis

Multivariate multilevel regression models were used to examine intervention effects on outcomes, controlled for background characteristics (i.e., age, gender, location, type of school, grade, BMI z-score).

Results

The intervention group showed significant improvements in total dietary knowledge (B = 12.74, p < 0.001) and intake of healthy items (B = 1.89, p < 0.001), compared to the control group. Intake of unhealthy items decreased significantly (B = -1.43, p < 0.001), compared to the control group. These results were adjusted for age, gender, type of school, location, BMI z-score, study group, and score at baseline.

Conclusion and Implications

Sahtak bi Sahnak is an effective and culturally appropriate school-based intervention for targeting diet among a variety of Lebanese adolescents.

Theoretical and practical approaches for dietary behavior change in urban socioeconomically disadvantaged adolescents: a systematic review

CONTEXT

There is limited evidence on strategies used to promote dietary behavior changes in socioeconomically disadvantaged urban adolescents and on their effectiveness.

OBJECTIVE

A synthesis of nutrition interventions used in this group of adolescents is provided in this systematic review.

DATA SOURCES

Five electronic databases (PubMed, Web of Science, CINAHL, PsycINFO, and ERIC) were searched until November 2020 to identify relevant studies.

DATA EXTRACTION

Forty-six manuscripts (n = 38 intervention studies) met the inclusion criteria. Quality was assessed with the Effective Public Health Practice Project Quality Assessment Tool. A qualitative synthesis summarizing data on study characteristics was conducted.

DATA ANALYSIS

Studies were classified by intervention type as those focusing on hedonic determinants of dietary intake (n = 1), environmental changes to promote a specific dietary intake (n = 3), cognitive determinants (n = 29), and multicomponent strategies (n = 13). The social cognitive theory was the most applied theoretical framework, either alone or combined with other frameworks. Most of the intervention studies targeted multiple dietary outcomes, and success was not always reported for each.

CONCLUSIONS

Despite the heterogeneity of the studies and lack of combination of dietary outcomes into dietary scores or patterns to evaluate changes on the individuals' whole diets, long-term, theory-driven interventions targeting a single dietary factor seem promising in obtaining sustainable dietary behavior changes.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020188219.

What is a "Snack"? Perspectives from Adolescents in Urban Communities

Snacking contributes significantly to U.S. adolescents' dietary intake and is a particularly significant eating occasion for urban adolescents, who have high amounts of food autonomy and access to corner stores. Consequently, research has focused on understanding and improving snacking among urban adolescents. However, the word "snack" possesses several definitions in the literature, leading to inconsistences in research efforts. As such, the aim of this study was to explore the definition of a snack among urban adolescents by conducting phone interviews with 30 adolescents from a Boys & Girls Club in New York City. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Overall, adolescents defined a snack as a small, unhealthy food item that can be quickly eaten to reduce hunger between meals. Future directions include using the definition of a snack that emerged from this study to improve subsequent adolescent snacking interventions.

School-based nutrition education improves breakfast-related personal influences and behavior of Indonesian adolescents: a cluster randomized controlled study

BACKGROUND/OBJECTIVES

Many adolescents in developing countries skip breakfast. Innovative nutrition education (NE) strategies are needed to enhance knowledge and skills related to the breakfasts of adolescents in a low socioeconomic setting. The objective was to evaluate short- and long-term effects of a multi-strategy, school-based NE intervention on adolescents' breakfast-related personal influences and behaviors.

SUBJECTS/METHODS

An intervention study with a cluster randomized controlled trial design was conducted in 4 senior high schools in Makassar, Indonesia. The multi-strategy NE intervention was delivered for 3 months. Data were collected using a self-administered questionnaire and a 3-day breakfast recall (face-to-face interview). Wilcoxon, McNemar, and Mann-Whitney tests were used to determine intra- and intergroup differences.

RESULTS

Unlike knowledge, improvement was observed in attitude and self-efficacy scores in the intervention groups (IGs) (P < 0.01); however, no significant changes were observed in the control group (CG). More students showed improved motivation in the IG than in the CG (P > 0.05). Changes in breakfast frequency and macronutrient intake from breakfast were greater in the IG than in the CG (P < 0.05).

CONCLUSIONS

A multi-strategy NE intervention is effective in producing positive changes in breakfast-related attitude, self-efficacy, and motivation of adolescents from a low-middle socioeconomic setting. The intervention improved breakfast frequency and nutrient intake. This intervention has promise for sustaining the observed changes over the long-term.

Outcome evaluation of fruits and vegetables distribution interventions in schools: a systematic review and meta-analysis

OBJECTIVE

Fruits and vegetables (FV) distribution interventions have been implemented as a public health strategy to increase children's intake of FV at school settings. The purpose of this review was to examine whether snack-based FV distribution interventions can improve school-aged children's consumption of FV.

DESIGN

Systematic review and meta-analysis of articles published in English, in a peer-reviewed journals, were identified by searching six databases up to August 2020. Standardised mean differences (SMD) and 95 % CI were calculated using a random effects model. Heterogeneity was quantified using I2 statistics.

SETTING

Population-based studies of interventions where the main focus was the effectiveness of distributed FV as snacks to schoolchildren in North America, Europe and Pacific were included.

RESULTS

Forty-seven studies, reporting on fifteen different interventions, were identified; ten studies were included in the meta-analysis. All interventions were effective in increasing children's consumption of FV, with only one intervention demonstrating a null effect. Pooled results under all classifications showed effectiveness in improving children's consumption of FV, particularly for multi-component interventions at post-intervention (SMD 0·20, 95 % CI 0·13, 0·27) and free distribution interventions at follow-up (SMD 0·19, 95 % CI 0·12, 0·27).

CONCLUSIONS

Findings suggest that FV distribution interventions provide a promising avenue by which children's consumption can be improved. Nonetheless, our results are based on a limited number of studies, and further studies should be performed to confirm these results. More consistent measurement protocols in terms of rigorous study methodologies, intervention duration and follow-up evaluation are needed to improve comparability across studies.

Children Learn, Children Do! Results of the "Planning Health in School", a Behavioural Change Programme

The ‘Planning Health in School’ programme (PHS-pro) is a behavioural change intervention to assess and improve the eating habits of children, particularly the intake of fruit and vegetables, and to guide them towards healthy choices. The programme and its educational components are based on the Transtheoretical Model of stages of change to integrate nutritional literacy and build up problem-solving and decision-making skills. Children (n = 240, ages 10–12) of one large suburban school in Porto’s metropolitan area (Portugal) were evaluated throughout PHS-pro implementation during one school year in a repeated time–series design. Children’s outcome evaluations were conducted through seven 3-day food records for nine eating behaviour, documented after each learning module and through participatory activities which analysed attitudes, preferences and expectations. Changes were observed in children’s eating behaviour, supported by changes in motivation as perceived in their attitudes and expectations. Significant changes were found in a higher consumption of vegetable soup (p = 0.003), milk products (p = 0.024), and fruit (p = 0.008), while the consumption of high-energy dense food (p = 0.048) and soft drinks (p = 0.042) significantly decreased. No positive effects on fried food, water, vegetables and bread consumption were found. The PHS-pro intervention proved to be effective in developing healthy eating behaviour in young people.

Development and Pilot Testing of a Food Literacy Curriculum for High School-Aged Adolescents

Adolescent obesity and poor diet quality are increasingly prevalent and could be mitigated with attainment of food literacy. However, as these programs for adolescents are lacking, the purpose of this project was to develop a food literacy curriculum for high school-aged adolescents. The curriculum was designed in accordance with food literacy attributes and components utilizing Backward Design, Social Cognitive Theory, and Constructivism. After expert committee review, pilot testing was completed in two low-income communities by a trained facilitator and observer. Detailed observations were collected during pilot testing to assess achievement of learning objectives. Modifications were made to lesson procedures as required. The resulting curriculum, Teens CAN: Comprehensive Food Literacy in Cooking, Agriculture, and Nutrition, contains 12 modules of experiential lessons and application activities within three topics. Agriculture lessons concentrate on the food supply chain and food environments; nutrition lessons include food groups while focusing on nutrients of concern for underconsumption; and cooking lessons include food safety, budgeting, and preparation. Teens CAN provides a comprehensive and necessary approach to advancing food literacy in adolescents. Future directions include assessing dietary implications after participating in Teens CAN lessons and employment of an innovative two-tiered cross-age teaching model.

Nutrition across the curriculum: a scoping review exploring the integration of nutrition education within primary schools

Primary schools contribute to promoting healthy eating behaviour and preventing overweight and obesity by providing nutrition education. Research highlights the importance of improving teachers' programme implementation to enhance intervention effectiveness. An integrative approach has been suggested to reduce time barriers that teachers currently experience in teaching nutrition. This scoping review explores use and effectiveness of integrative teaching in primary-school-based nutrition education programmes. Six databases were searched for primary-school-based interventions on nutrition education. Papers reporting on integration of nutrition topics within core curriculum were included. Abstracts and full texts of potentially relevant articles were screened to determine eligibility. Next, data were extracted and tabulated. Findings were collated and summarised to describe intervention characteristics, subject integration and effectiveness of the included programmes. Data describing integration of nutrition into the primary school curriculum were extracted from 39 eligible papers. Nutrition education programmes often involve lessons about food groups and are frequently embedded within the mathematics, science or literacy syllabus. Although articles report on the integration of nutrition, the use of this approach was not commonly described in detail. Only seven papers discussed student outcomes related to the integration of nutrition education within core subjects. The ability to draw strong conclusions about school-based nutrition intervention effectiveness is limited by the current lack of programme description and methodological issues. Hence, more research is warranted to inform evidence on effectiveness of integrative nutrition education for both teacher and student outcomes. Future studies that include greater detail regarding the integrative approach are needed.

Identifying Differences in Nutrition-Related Learning Interests of Adolescent Students

BACKGROUND

In this study, we examined nutrition-related topics among adolescent students attending schools with different Indices of Community Socio-Educational Advantage (ICSEA).

METHOD

Participating students (N = 206) from 5 schools in Western Australia completed a paper-based questionnaire on nutrition-related topics. Frequencies and independent chi-square tests were used to identify differences between sexes and school ICSEA.

RESULTS

Of the participating students, 75% were interested in learning about 8 of 16 topics. We found statistically significant differences by sex (p < .01) for "Eating the right foods for preventing illness and disease," "Eating the right food for being active" among girls, and "Reducing food waste" among boys. We also noted differences by school ICSEA.

CONCLUSION

Acknowledging sex and socioeducational differences in teaching and learning may help teachers to engage adolescent students in nutrition education.

Nutritional Knowledge and Dietary Intake Habits among Pregnant Adolescents Attending Antenatal Care Clinics in Urban Community in Ghana

INTRODUCTION

Proper nutrition during pregnancy is important for the wellbeing of the mother and foetus and supports health during pregnancy, delivery, and breastfeeding. However, there are little data on nutritional knowledge and dietary intake among adolescents who are pregnant in Ghana. Hence, the study assessed the nutritional knowledge and eating habits of this vulnerable group in the Ledzokuku-Krowor Municipality, Ghana.

METHODS

The study was cross-sectional and employed a multistage sampling technique to select 423 participants. The study was conducted between October and November 2019. A statistical software was used to analyse data and employed Pearson's chi-square and logistics regression to assess associations between the outcome and predictor variables. A p value <0.05 at a 95% confidence interval was considered statistically significant.

RESULTS

Less than half (44.9%) of the pregnant adolescents have high nutritional knowledge. About 19.4% of them have good eating habits, while 23.9%, 18.2%, and 6.4% of them do not take breakfast, lunch, and supper, respectively. However, 15.6%, 13.9%, and 9.2% do take snacks after breakfast, lunch, and supper, respectively. About 55.9%, 59.8%, and 23.0% do not take their breakfast, lunch, and supper on time, respectively. Additionally, only 3.8% of them do take fruits and vegetables daily, while 9.7%, 23.2%, 30.0%, and 26.5% of them do take animal products, energy drinks, carbonated drinks, and legumes/nuts/seeds daily, respectively. The study showed that educational level (p=0.014), occupation (p=0.016), ethnicity (p=0.017), and number of pregnancies (p=0.021) were associated with good eating habits.

CONCLUSION

Eating habit of adolescent pregnant women was not encouraging. Therefore, the municipal health authority with the concerned stakeholders should intensify efforts, including nutritional education to improve good eating habits, such as taking snacks in between meals, eating on time, and balance diet among pregnant adolescents, and to reduce adolescent pregnancy in the municipality.

Nutrition Curriculum Training and Implementation Improves Teachers' Self-Efficacy, Knowledge, and Outcome Expectations

OBJECTIVE

To examine the effects of training and implementation of Forecasting Your Future: Nutrition Matters on teachers' self-efficacy to teach nutrition and teachers' nutrition knowledge and explore outcome expectations for students.

METHODS

A mixed-methods study, with Indiana Family and Consumer Sciences high school teachers randomized to control and intervention, was conducted using baseline surveys, implementation of new or usual curriculum, follow-up survey(s), and semistructured interviews. Self-efficacy and knowledge were analyzed by hierarchical linear modeling. Interviews were thematically analyzed using a 5-phase process to identify outcome expectations.

RESULTS

Intervention teachers (n = 17) had greater increases in nutrition knowledge (P = 0.028) and self-efficacy (P = 0.010) compared with controls (n = 18). Interviews revealed that teachers sought to affect students' long-term health by providing knowledge and skills to make healthy choices.

CONCLUSIONS AND IMPLICATIONS

This training with updated curricula and implementation improved theoretical determinants of effective nutrition instruction. Teachers expected student learning will contribute to future eating behaviors.

A Nutrition Intervention to Promote the Consumption of Pulse-Based Foods in Childcare Centers: Protocol for a Multimethod Study

Background

Plant-based foods, including pulses (dry beans, lentils, chickpeas, and peas), have gained worldwide attention owing to their health and environmental benefits. Despite high production, the consumption of pulses is low in Canada. Behavior change interventions systematically designed to promote the consumption of pulse-based foods are scarce.

Objective

We describe the utilization of intervention mapping (IM) in the development of a multicomponent nutrition intervention aimed at promoting consumption of pulse-based foods among preschool children in childcare centers in Saskatchewan, Canada.

Methods

The Pulse Discovery Toolkit intervention was developed following the six steps of the IM protocol. Decisions at each step were either based upon literature review, expert consultation, pretesting, or a combination of these. Following the initial phase of the study, which focused on intervention development, phases II and III of the study were concerned with pilot testing and roll-out of the intervention, respectively. In total, one, two, and four childcare centers participated in phases I, II, and III, respectively. A multimethod approach was designed to evaluate the intervention during pilot testing and roll-out.

Results

The application of IM steps 1 to 3 in phase I resulted in the creation of performance objectives at different levels, including at the individual level (preschool children), and the social and environmental levels (parents, early childhood educators, and cooks). These objectives were then used to create a matrix of objectives matching the constructs of the social cognitive theory while taking Piaget cognitive development into consideration. This step was followed by defining program components, implementation, adoption, and evaluation strategies, which were utilized in phases II and III. Data have been collected from 2015 to 2018 and analyzed. The results will be reported elsewhere.

Conclusions

The IM protocol provided a rigorous framework for the development of a multicomponent evidence-based intervention to promote pulse-based foods in childcare centers.

International Registered Report Identifier (IRRID)

RR1-10.2196/22775

Process evaluation of fruit and vegetables distribution interventions in school-based settings: A systematic review

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Assesses how school fruit & vegetable distribution interventions are implemented.

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Child fruit & vegetable intake is influenced by how intervention is implemented.

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Recommendations for implementing fruit & vegetable interventions in schools.

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Studies should also consider sustainability, cost-effectiveness and implementation.

Despite the importance of process evaluation in program evaluations, research has focused primarily on the effectiveness of fruit and vegetables (FVs) distribution interventions on children’s consumption, with little attention given to how these interventions achieve their outcomes. Five bibliographic databases (Embase, PubMed, ProQuest, Scopus, and Web of Science Core Collection) were searched in June 2019 for studies of interventions where the main focus was the implementation of distributed FVs to school-aged children as a snack. The Critical Appraisal Skills Programme (CASP) tool was used to appraise the risk of bias within included studies. Data were extracted based on study characteristics and findings. Results identified 24 studies reporting on 11 interventions and 1 policy. The findings of this systematic review indicate that the majority of the studies included limited references to implementation research. Recurring limitations include an absence of an evaluation theoretical framework and the data collection methods used. Also, several factors were identified as informing the success of snack-based FVs distribution programs, including participation of the school community, school characteristics, background knowledge, and parental engagement. Lack of timely FVs delivery, limited funding, inadequate awareness about the program, insufficient teachers’ time, and food waste were identified as challenges to successful programming. Findings indicate that distributing FVs to school-aged children as a snack can increase their consumption, but only with proper implementation. Further evaluative research is required to better inform future implementation of snack-based FV distribution interventions in school settings.

Primary school-based nutrition education intervention on nutrition knowledge, attitude and practices among school-age children in Ghana

This study was performed to evaluate the effect of a six-week nutrition education intervention on the nutrition knowledge, attitude, practices, and nutrition status of school-age children (aged 6-12 years) in basic schools in Ghana. Short-term effects of nutrition education training sessions on teachers and caregivers were also assessed. Pre-post controlled design was used to evaluate the program. Intervention groups had significantly higher nutrition knowledge scores (8.8 ± 2.0 vs. 5.9 ± 2.1, P < 0.0001) compared to controls in the lower primary level. A higher proportion of children in the intervention group strongly agreed they enjoyed learning about food and nutrition issues compared to the control group (88% vs. 77%, P = 0.031). There was no significant difference in dietary diversity scores (4.8 ± 2.0 vs. 5.1 ± 1.4, P = 0.184) or in measured anthropometric indices (3.6% vs. 8.2%, P = 0.08). A marginally lower proportion of stunted schoolchildren was observed among the intervention group compared to the control group (3.6% vs. 8.2%, P = 0.080). Nutrition knowledge of teachers and caregivers significantly improved (12.5 ± 1.87 vs. 9.2 ± 2.1; P = 0.031) and (5.86 ± 0.73 to 6.24 ± 1.02, P = 0.009), respectively. Nutrition education intervention could have positive impacts on knowledge and attitudes of school children, and may be crucial in the development of healthy behaviors for improved nutrition status.

Forecasting Your Future: Nutrition Matters Curriculum with Teacher Training Promotes Students to Try New Fruits and Vegetables

BACKGROUND

Many high school students do not consume the recommended amounts of fruits and vegetables.

OBJECTIVE

This study evaluated student outcomes from a new nutrition curriculum that includes messages from the 2015-2020 Dietary Guidelines for Americans with a teacher training component for high school Family and Consumer Sciences (FACS) teachers.

METHODS

A cluster-randomized controlled study was conducted with 1104 students in FACS classes from 35 schools, taught by teachers trained in implementing a new curriculum (intervention) and teachers using their usual curricula (control). Students completed online surveys at the beginning and end of the semester, that is, pre- and postexposure to the nutrition curricula. Intention-to-treat analyses as hierarchical linear modeling were performed to determine if the intervention students had significant changes compared with the control students for knowledge of nutrition concepts, familiarity of, preferences for, affinity toward, number of times trying new, and daily times eating fruits and vegetables. Per-protocol analyses used the same hierarchical linear model but instead of control and intervention groups, students were split into 3 levels describing the amount of the new curriculum they received (0%, 1-50%, and 51-100%).

RESULTS

Students exposed to 51-100% of the new curriculum tried more fruits and vegetables than both the control students and the students that received 1-50% of the curriculum (P = 0.009 for fruits and P = 0.002 for vegetables). Additionally, there were higher increases in the number of times intervention students tried a new fruit (P = 0.027) and vegetable (P = 0.022) compared with the control students, regardless of the amount of curriculum received.

CONCLUSIONS

Our findings show that the curriculum, Forecasting Your Future: Nutrition Matters, has promise for increasing exposure to new fruits and vegetables for students. If teachers use most of the curriculum, students are likely to try more new fruit and vegetables, which could ultimately contribute to improved health.

Dietary diversity and associated factors among adolescents in eastern Uganda: a cross-sectional study

BACKGROUND

Globally adolescents constitute over 16% but in SSA, they make up 23% of the population. While little is known about diets of these adolescents, rapid changes in physiological and social processes undergone require adequate diets. This study aimed to determine dietary diversity and associated factors among adolescents residing in the Iganga -Mayuge HDSS.

METHODS

As part of the African Research, Implementation Science, and Education (ARISE) Network, we analysed collected data among 598 adolescents to assess the health status and adolescents' behaviour. Dietary diversity was scored using the 9 food group categories as per the Food and Agriculture Organization -WDDS. Crude and adjusted prevalence rate ratios were estimated using the modified Poisson regression model to identify associated factors.

RESULTS

Among the participants, 45.3% had a low dietary diversity score. Proportions of adolescents who consumed from the different food categories over a 24-h period were; cereals/roots/tubers (99.7%), fats & oils (87.0%), spices & beverages (84.1%), sweets (77.1%), legumes (66.2%), other non-vitamin A-rich vegetables (53.8%), dark green leafy vegetables (42.3%), meat/poultry/fish (33.1%), dairy products (32.9%), eggs (11.2%), vitamin A-rich fruits and vegetables (33.4%) and other fruits (8.2%). Staying with a single parent or guardian, low socio-economic class, and dependency on home meals was associated with low dietary diversity.

CONCLUSIONS

Adolescents diets were low in diversity and characterised with low micronutrients source foods, but plenty of fats and oils. Interventions to address contributing factors to the burden ought to target the parenting contexts of the adolescents residing in rural eastern Uganda.

Adolescent Obesity: Diet Quality, Psychosocial Health, and Cardiometabolic Risk Factors

Obesity is a multifaceted chronic condition with several contributing causes, including biological risk factors, socioeconomic status, health literacy, and numerous environmental influences. Of particular concern are the increasing rates of obesity in children and adolescents, as rates of obesity in youth in the United States have tripled within the last three decades. Youth from historically disadvantaged backgrounds tend to have higher rates of obesity compared to other groups. Adolescents often do not meet intake recommendations for certain food groups and nutrients, which may contribute to a heightened risk of obesity. With obesity disproportionately affecting adolescents (ages 12–19 years), negative effects of excess adiposity may be particularly salient during this critical period of development. The presentation of chronic cardiometabolic disease symptoms typically observed in adults, such as hypertension, hyperglycemia, dyslipidemia, and inflammation, are becoming increasingly common in adolescents with obesity. Additionally, there is dynamic interplay between obesity and psychosocial health, as adolescents with obesity may have increased levels of stress, depressive symptoms, and reduced resilience. To reduce and prevent adolescent obesity, the implementation of theory-driven multicomponent school- and community-based interventions have been suggested. These interventions promote knowledge and self-efficacy for healthful practices that have the potential to progress to sustained behavior change.

Changing the behaviour of children living in Dutch disadvantaged neighbourhoods to improve breakfast quality: Comparing the efficacy of three school-based strategies

Children's breakfast habits are suboptimal. A novel school-based education programme was developed and tested with the aim of improving children's attitude, knowledge and breakfast quality. A pre- and post-test design was used with four conditions: group-based education, role modelling, tailored feedback with goal setting, and a combination of these three delivery modes. Two hundred eighty children from disadvantaged communities (9.3 ± 0.8 years) participated in three lessons at school over a two-month period. Children's attitude, knowledge and breakfast behaviour were evaluated by a pre- and post-questionnaire completed by the children. A follow-up measure was executed at 24 weeks. The data were analysed by repeated measures ANOVA. At baseline, 90% of the children ate breakfast on the measurement day; 60-76% of the children ate breakfast daily. Between pre- and post-test, a significant time effect was found for children's attitude, self-efficacy, knowledge and behaviour (all p < 0.05). Children in the feedback condition improved most favourably: correct classification of breakfast products increased by 10 products (out of 44) and breakfast quality score improved by 25 points (on a 100-point scale). The feedback condition also resulted in positive changes in the home setting. The follow-up test showed a decline in children's knowledge and their breakfast quality across conditions. To conclude, this study showed that a three-lesson school programme based on individual feedback and goal setting is most effective for changing knowledge on breakfasting and self-reported breakfast quality among children aged 8-10 years living in disadvantaged neighbourhoods. To maintain effectiveness, longer-term programmes embedded in the school curriculum are needed to enhance breakfast quality. Future research should explore the optimal duration and intensity of such programmes and should incorporate the topic of suitable portion sizes.

A multilevel approach for promoting physical activity in rural communities: a cluster randomized controlled trial

Background

Physical activity (PA) has demonstrated a decreased risk in various cancers and other chronic diseases; however, rural residents are less likely to attain recommended levels of PA compared to urban and suburban counterparts. Given rural residents make up 15% of the United States population, there is a need for novel approaches to increase PA among this population. The goal of the present study is to investigate the effectiveness of a multilevel intervention to increase PA rates among rural residents.

Methods/design

Guided by an ecological framework, a group-randomized design will be used to evaluate the effects of a three-level intervention for increasing PA among adult residents residing in 6 rural communities (n = 600) along with 6 control communities (n = 600). The intervention includes components at the individual (short message service [SMS] text messages), interpersonal (social support in walking groups), and community levels (events at existing trails). Innovative methods to encourage participation will be employed as well as a focus on life priorities (family, recreation, hobbies) other than health. Aim 1 includes a literature review and key informant interviews to determine the local contexts for intervention adaptation. Aim 2 will employ a set of interventions at the individual, interpersonal, and community-levels to evaluate their impact on moderate-to-vigorous PA as measured by self-reported (telephone survey) and objectively assessed (accelerometry) measures. These data are supplemented by location based on Global Positioning System and community audits, which provide information on recreational amenities, programs/policies, and street segments.

Discussion

This study is among the first of its kind to test a multilevel intervention in a rural setting, address life priorities that compliment health outcomes, and examine moderation between behavioral interventions and the natural environments where people are physically active. Our results will influence the field by enhancing the ability to scale-up innovative, PA interventions with the potential to reach high-risk, rural populations.

Trial registration

Clinical Trials NCT03683173, September 25, 2018.

Choice Architecture in Appalachian High Schools: Evaluating and Improving Cafeteria Environments

School meals are a primary source of nutrition for many adolescents. Determining factors that influence the selection of various foods can provide insight on strategies to improve students' cafeteria choices. This evaluation and observation was conducted at three Appalachian high schools to assess the cafeteria environment. The study developed and implemented an assessment tool created using principles of choice architecture and behavioral economics building on the work of the Cornell Center for Behavioral Economics in Child Nutrition Programs (BEN Center). The assessment tool scored eight components of the lunchroom-the exterior, hot serving area, cold serving area, salad bar, beverage area, payment station, dining area and grab-n-go, where a higher score equals healthier components offered. High school (HS) #1 earned 73/128 points (57%), HS #2 earned 69/128 (54%), and HS #3 earned 53/102 (52%). HS #3 did not have a grab-n-go option and the final score was out of 102. Video observation was used to collect data on lunchroom activity during mealtimes. Each school received reports that highlight the results and suggest improvements to raise their score. The scoring tool represents a novel way to assess the health of school lunches, provide insights on how to improve the healthfulness of students' lunch choice, and improve overall nutrition status.

The use of social media in nutrition interventions for adolescents and young adults-A systematic review

OBJECTIVE

Social media is a potentially engaging way to support adolescents and young adults in maintaining healthy diets and learning about nutrition. This review identifies interventions that use social media to promote nutrition, examines their content and features, and evaluates the evidence for the use of such platforms among these groups.

MATERIAL AND METHODS

We conducted a systematic search of 5 databases (PubMed, CINAHL, EMBASE, PsycINFO, and ACM Digital Library) for studies that included: 1) adolescents and/or young adults (ages 10-19; ages 18-25); 2) a nutrition education or behavior change intervention component, or outcomes related to nutrition knowledge or dietary changes; and 3) a social media component that allowed users to communicate or share information with peers.

RESULTS

16 articles were identified that included a social media component in a nutrition-related intervention for adolescents or young adults. Interventions included features in 7 categories: social media; communication; tracking health; education; tailoring; social support; and gamification. 11 out of the 16 studies had at least one significant nutrition-related clinical or behavioral outcome.

CONCLUSION

Social media is a promising feature for nutrition interventions for adolescents and young adults. A limited number of studies were identified that included social media. A majority of the identified studies had positive outcomes. We found that most studies utilized only basic social media features, did not evaluate the efficacy of social media components, and did not differentiate between the efficacy of social media compared to other delivery mechanisms.

Tackling the Consumption of High Sugar Products among Children and Adolescents in the Pacific Islands: Implications for Future Research

The Pacific Islands are experiencing an obesity epidemic with a rate of overweight and obesity as high as 80% among adults in some Pacific Island nations. Children and adolescents in the region are also affected by overweight and obesity, which is alarming due to the increased likelihood of remaining overweight as an adult. Research supports an association between poor diet and an increased risk of obesity and development of non-communicable diseases (NCDs). Excess consumption of free sugars is associated with poorer overall diet quality and increased risk of weight gain, chronic inflammation and dental caries. Traditional diets in the Pacific Islands are being supplemented with processed, high-sugar foods and beverages; thus, there is a clear need for effective interventions promoting positive dietary behaviors in the region. School and community based interventions offer an opportunity to promote positive behavior change among children and adolescents. This review aims to evaluate interventions targeting the consumption of high-sugar products in this population in the Pacific Islands.

Theory-informed nutrition education curriculum Tools For Feeling Good promotes healthy eating patterns among fifth grade pupils: cross-sectional study

BACKGROUND

The eating patterns of school-aged children rarely meet recommendations: meal frequency is irregular and the consumption of vegetables is lower and sugar-sweetened products higher than recommended. Although school is an excellent arena for nutrition education to support pupils eating patterns, teachers usually lack efficient tools. The present study aimed to develop a curriculum for nutrition education to be used by teachers and to examine its efficacy in the school environment with respect to the eating patterns of pupils.

METHODS

The curriculum was developed in collaboration with school teachers using self-determination theory as a theoretical standpoint. The Health at Every Size concept and sensory-based food education were utilised in the curriculum. Self-reported questionnaires were used to assess the feasibility and impact of the curriculum. Fourteen teachers implemented the curriculum during 2012-2013 with 194 pupils aged 10-13 years (fifth and sixth grades). The control schools included 140 pupils of the same age not following the curriculum.

RESULTS

The teachers reported that the curriculum was easy to integrate in the school environment. The fifth graders improved their breakfast frequency, increased their consumption of vegetables and reduced their consumption of ice cream, sweets and sugar-sweetened drinks. No improvement was found in the fifth graders at the control schools. In the sixth graders, no dietary changes were detected in the intervention or control schools.

CONCLUSIONS

The pupils in the fifth grade appeared to comprise a responsive target group for nutrition education at schools. The curriculum offers a promising approach for developing healthy eating patterns among fifth graders. Collaboration with teachers in developing the curriculum likely enhanced its feasibility and teacher commitment for implementation.

Evaluation of a community-based, family focused healthy weights initiative using the RE-AIM framework

Background

Childhood overweight and obesity is a major public health concern. Community-based interventions have the potential to reach caregivers and children. However, the overall health impact of these programs is rarely comprehensively assessed. This study evaluated a physical activity and healthy eating family program (Healthy Together; HT) using the RE-AIM framework.

Methods

Ten sites implemented the 5-week program. Thirty-nine staff members and 277 program participants (126 caregivers [M_age = 35.6] and 151 children [M_age = 13]) participated in the evaluation. Each RE-AIM dimension was assessed independently using a mixed-methods approach. Sources of data included archival records, interviews and surveys. Effectiveness outcome variables were assessed at pre- and post-intervention and 6-month follow-up.

Results

Reach: HT participants were almost entirely recruited from existing programs within sites. Effectiveness: Caregivers’ nutrition related efficacy beliefs increased following HT (ps < .03). Participation in HT was not associated with significant changes in physical activity or nutrition behaviour or perceived social support (ps > .05). Knowledge surrounding healthy diets and physical activity increased in children and caregivers (ps < .05). Adoption: Thirty-five percent of sites approached to implement HT expressed interest. The 10 sites selected recruited existing staff members to implement HT. Implementation: Program objectives were met 72.8% of the time and 71 adaptations were made. HT was finance- and time-dependent. Maintenance: Two sites fully implemented HT in the follow-up year and 5 sites incorporated aspects of HT into other programs.

Conclusions

Working alongside organizations that develop community programs to conduct comprehensive, arms-length evaluations can systematically highlight areas of success and challenges. Overall HT represents a feasible community-based intervention; however further support is required in order to ensure the program is effective at positively targeting the desired outcomes. As a result of this evaluation, modifications are currently being implemented to HT.

Electronic supplementary material

The online version of this article (10.1186/s12966-017-0638-0) contains supplementary material, which is available to authorized users.

Nutritional interventions for adolescents using information and communication technologies (ICTs): A systematic review

A cost-effective and interactive way of promoting healthy nutrition behaviors among adolescents is using information and communication technologies (ICTs). We systematically reviewed studies to identify technologies and their main characteristics used for nutritional interventions for adolescents, as well as to evaluate their quality and effectiveness. Our full protocol is available on the PROSPERO website (#CRD42016035882). A search was conducted across five databases for articles describing nutritional interventions that used ICTs designed mainly for healthy adolescents. Randomized controlled trials, quasi-experimental and observational studies, and full and original papers, all of them published from 2005 to 2015, were included. Study quality was assessed by the Effective Public Health Practice Project Quality Assessment Tool. Our search yielded 559 titles and abstracts. Eleven studies met the inclusion criteria. Participants were recruited mostly from schools. Study follow-up ranged from two weeks to two years. Four interventions were based on the Social Cognitive Theory. Interventional strategies included computer games, programs, text messages, and interactive CD-ROMs. Nine studies used computer-mediated ICTs. Five studies focused on multiple behaviors simultaneously. Participants were exposed to interventions only once, daily, weekly, or according to a pre-determined number of lessons. Five studies had significant outcomes. Our quality assessment revealed three studies to be weak due to non-representativeness of their samples and usage of non-validated questionnaires. Besides the heterogeneity and poor quality of the analyzed studies, it can be suggested that long-term interventions for adolescents that make use of frequent exposure to technological resources, and that have a theoretical component aimed at a single health behavior change, tend to be more successful.

Adolescents with at-risk eating and lifestyle behaviors are affected by after school schedules across the clinical weight spectrum

OBJECTIVE

Evaluate adolescent lifestyle patterns to develop more effective health promotion programs.

METHODS

An interview approach was employed to gain in-depth understanding of eating and activity behaviors. Adolescents aged 13-18 years (n=43) from clinically normal and obese weight categories were enrolled. Nutrient intake and food group servings were obtained from a food frequency questionnaire.

RESULTS

Four participant subgroups were identified and labeled: "Idle, Engaged, Balanced and Working." "Idle" adolescents were sedentary, sometimes napped, and often snacked after dinner. "Engaged" adolescents participated in extra-curricular activities for the majority of their after school hours. "Balanced" adolescents participated in a single after-school activity followed by sedentary time; they consumed meals consistently and often snacked after dinner. "Working" adolescents were the least sedentary with limited sleep duration and inconsistent meals; they often substituted a meal with a snack. Weight status did not differentiate subgroups effectively.

CONCLUSIONS

Each group demonstrated at-risk behaviors for obesity. Future programs should consider after-school schedules and use activity and meal pattern assessments, not simply weight status, for program tailoring.

PRACTICE IMPLICATIONS

Pediatric health care providers could identify at-risk behaviors through routine assessment of diet and activity patterns in combination with weight monitoring.

Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations

BACKGROUND

Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes. Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions. As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG)-akin to similar guidelines in other health fields-offer a valuable, targeted prevention tool to improve public health outcomes.

OBJECTIVES

To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process.

SEARCH METHODS

We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use.

SELECTION CRITERIA

We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes.

DATA COLLECTION AND ANALYSIS

We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review. We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches. Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE) criteria, and translated it into the LRCUG recommendations by the author expert collective on the basis of an iterative consensus process.

MAIN RESULTS

For most recommendations, there was at least "substantial" (i.e., good-quality) evidence. We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use-related health risks is abstinence, (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years), (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)-ratio cannabis products, (4) abstain from using synthetic cannabinoids, (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods, (6) avoid deep or other risky inhalation practices, (7) avoid high-frequency (e.g., daily or near-daily) cannabis use, (8) abstain from cannabis-impaired driving, (9) populations at higher risk for cannabis use-related health problems should avoid use altogether, and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use).

AUTHORS' CONCLUSIONS

Evidence indicates that a substantial extent of the risk of adverse health outcomes from cannabis use may be reduced by informed behavioral choices among users. The evidence-based LRCUG serve as a population-level education and intervention tool to inform such user choices toward improved public health outcomes. However, the LRCUG ought to be systematically communicated and supported by key regulation measures (e.g., cannabis product labeling, content regulation) to be effective. All of these measures are concretely possible under emerging legalization regimes, and should be actively implemented by regulatory authorities. The population-level impact of the LRCUG toward reducing cannabis use-related health risks should be evaluated. Public health implications. Cannabis control regimes are evolving, including legalization in North America, with uncertain impacts on public health. Evidence-based LRCUG offer a potentially valuable population-level tool to reduce the risk of adverse health outcomes from cannabis use among (especially young) users in legalization contexts, and hence to contribute to improved public health outcomes.

Middle school nutrition knowledge tool development and evaluation in North Carolina

PURPOSE –

This study aims to develop and empirically assess an instrument for measuring nutrition knowledge aligned to the North Carolina (NC) Healthful Living Essential Standards for teaching nutrition. The instrument was critically evaluated and used to assess nutrition knowledge in Eastern NC students.

DESIGN/METHODOLOGY/APPROACH –

Researchers evaluated 250 students in 16, eighth-grade classrooms using a 22-question researcher-developed nutrition knowledge questionnaire. Assessment questions were aligned with NC Healthful Living Essential Standards, which suggest students should be able to: apply tools to plan healthy nutrition, create strategies to improve dietary intake, create plans for lifelong health, and evaluate health information and products. Survey reliability and validity (face) were evaluated prior to study implementation. Descriptive statistics for individual items, total and individual standard scores were analyzed. Instrument efficacy was evaluated using item-difficulty and discrimination indexes.

FINDINGS –

The survey displayed appropriate levels of item difficulty with three exceptions: two questions were identified as too difficult, and one as too easy. The majority of items also displayed acceptable (>0.20) or excellent (>0.40) discrimination (17 out of 20). Average total nutrition knowledge score was 11.82-3.26 (53.7 per cent). Within aligned standards, students scored highest in creating plans for lifelong health (79 per cent) and lowest in evaluating health information (37.6 per cent).

ORIGINALITY/VALUE –

Study findings suggest eighth-grade students may only possess half the nutrition knowledge standards expected in the eighth grade. More instrument development is needed to supply researchers with standard means of assessing nutrition knowledge.

Parent healthful eating attitudes and motivation are prospectively associated with dietary quality among youth with type 1 diabetes

A family-based behavioral nutrition intervention grounded in Social Cognitive and Self-Determination Theories showed an increased intake of whole plant foods. This study examined 1) whether the intervention changed parent diet-related attitudes/beliefs, 2) whether these attitudes/beliefs were associated with youth diet quality, and 3) the moderating roles of youth age and parent nutritional knowledge. Youth with type 1 diabetes and their parents (n = 136, mean ± SD youth age = 12.6 ± 2.8 years) participated in an 18-month trial targeting intake of whole plant foods. Parents reported attitudes/beliefs (self-efficacy, outcome expectations, perceived barriers, autonomous and controlled motivation) for providing healthy food to their families, and type 1 diabetes-specific nutrition knowledge at 6, 12, and 18 months. Whole Plant Food Density (WPFD; cup or ounce equivalents per 1000 kcal of whole grains, fruit, vegetables, legumes, nuts and seeds) was calculated from 3-day youth food records. Linear mixed models estimated the intervention effect on parent attitudes/beliefs, associations of parent attitudes/beliefs with youth WPFD and the moderating roles of parent nutrition knowledge and youth age. There was no effect of the intervention on parent attitudes/beliefs. Across groups, higher parent self-efficacy and autonomous motivation were positively associated with youth WPF. Parent perceived barriers and negative outcome expectations were inversely associated with youth WPFD, especially when parents had higher nutrition knowledge. Youth age did not modify any associations. Parent diet-related attitudes/beliefs were associated with youth diet quality, highlighting the importance of parent psychosocial factors across this age range. Despite a positive effect on youth diet, the intervention did not affect parent attitudes/beliefs, suggesting it worked through a different mechanism.

Adolescents’ Needs Towards School-Based Nutrition Interventions

Background and Aims: This study aimed to identify adolescents’ knowledge and attitudes towards healthy eating and their needs and preferences towards school-based nutrition interventions, thus investigating the “must have” components on school-based nutrition interventions than can improve adolescents’ dietary patterns.

Material and Methods: To reach the proposed aims, we used a qualitative strategy of inquiry, by conducting semi-structured focus groups. We collected data in two urban schools from Cluj-Napoca, Romania. 32 adolescents aged 11 to 14 years old attended focus group discussions. Focus group discussions were audio-taped, transcribed and analyzed using thematic analysis.

Results: A viable strategy to deliver effective nutrition interventions for adolescents needs to address adolescents' interests and concerns, use visuals and stories to present nutrition related information, increase adolescents' self-efficacy in choosing healthy foods, train adolescents in having a balanced diet, promote healthy eating as acceptable for peers, and involve parents in nutrition interventions through home-based activities.

Conclusions: Improving adolescents' nutrition related knowledge and behavior and creating supportive environments is not sufficient in improving adolescents' dietary patterns. Practitioners should aim at designing school-based nutrition interventions addressing adolescents' specific needs and rely on the needs assessment process as a major component of the design.

Development of an Interactive Pregnant Adolescent Nutrition Education Workshop

The health of pregnant adolescents affects the well-being of future generations. Modifying unhealthy eating patterns among pregnant adolescents is critical because of their association with risk of poor pregnancy and birth outcomes. Therefore, it is important to provide age- and developmentally appropriate nutrition education during this time. To sustain healthy behavior changes, nutrition interventions must be grounded in theory and reflect both motivating factors and barriers to healthy eating. Factors such as taste preferences, personal self-efficacy, developmentally appropriate nutrition education, and hands-on meal preparation have been identified as influences on dietary patterns in this population. The purpose of this article is to describe the development of an evidence-based nutrition education program for pregnant adolescents based on Pender's health promotion model.

Pregnant Adolescents, Beliefs About Healthy Eating, Factors that Influence Food Choices, and Nutrition Education Preferences

INTRODUCTION

Healthy eating among pregnant adolescents is essential for the well-being of developing adolescent females and their fetuses, as well as for the prevention of adult chronic illness. Understanding factors that influence and prohibit healthy eating, along with preferences for nutrition education in the pregnant adolescent population, is critical when designing and implementing appropriate nutrition education programs. The purpose of this study was to collect individual viewpoints of pregnant adolescents to facilitate the development of a nutrition intervention.

METHODS

This qualitative study using focus group methodology was conducted among pregnant adolescents. Participants (N = 14) were recruited through and teen parenting programs in the Mid-Atlantic region. Focus groups were guided by 6 open-ended questions that were developed based on implications from a previous study that surveyed eating habits of pregnant adolescents. Data were analyzed and coded using verbatim transcripts. Transcripts were read carefully for overall content and identification of major categories and then compared for similar and contrasting data.

RESULTS

Four recurring themes emerged that described beliefs about healthy eating, influences on food choices, and nutrition education preferences: 1) pregnant adolescents demonstrate overall knowledge of healthy foods but are unwilling to give up unhealthy foods; 2) parents, offspring, and pregnancy influence healthy eating habits; 3) pregnant adolescents choose foods based on appearance and taste, cravings, convenience, and cost; and 4) pregnancy alters eating habits. Nutrition education in this population should be peer- and adolescent-focused and incorporate preferred methods of learning and favored incentives.

DISCUSSION

Pregnant adolescents are more likely to attend educational programs that are population-specific and peer-focused, and include incentives that make cooking easier, more convenient, and affordable. Program content should be available to potential participants ahead of time. Preferred methods of learning include video format, peer discussion, and hands-on cooking with active participation in food preparation. Foods that are prepared should be visually appealing and adolescent-friendly.

Evaluation of a Planned Behavior Theory-Based Intervention Programme to Promote Healthy Eating

The objective of the study was to test the effectiveness of an intervention program based on the theoretical framework of the Theory of Planned Behavior, with the addition of attitude strength and role identity. The aim was to alter adolescents' healthy eating attitudes and behaviour. In the sample were 335 high school students, who were divided into intervention and control groups. The intervention lasted 12 weeks and included posters and lectures promoting healthy eating. The measures included a questionnaire assessing the hypothesis and a food frequency questionnaire which measured eating habits. Analysis showed the intervention was effective in improving attitudes toward healthy eating and attitude strength, intention, perceived behavioral control, and healthy eating behaviour, but not effective in predicting subjective norms and role identity. Results provide evidence that intervention changed attitudes toward a behavior in a school setting.

Can Families Eat Better Without Spending More? Improving Diet Quality Does Not Increase Diet Cost in a Randomized Clinical Trial among Youth with Type 1 Diabetes and Their Parents

BACKGROUND

Although cost is a frequently cited barrier to healthful eating, limited prospective data exist.

OBJECTIVE

To examine the association of diet cost with diet quality change.

DESIGN

An 18-month randomized clinical trial evaluated a dietary intervention.

PARTICIPANTS AND SETTING

Youth with type 1 diabetes duration ≥1 year, age 8.0 to 16.9 years, receiving care at an outpatient tertiary diabetes center in Boston, MA, participated along with a parent from 2010 to 2013 (N=136). Eighty-two percent of participants were from middle- to upper-income households.

INTERVENTION

The family-based behavioral intervention targeted intake of whole plant foods.

MAIN OUTCOME MEASURES

Diet quality as indicated by the Healthy Eating Index 2005 (HEI-2005) (which measures conformance to the 2005 Dietary Guidelines for Americans) and whole plant food density (cup or ounce equivalents per 1,000 kcal target food groups) were calculated from 3-day food records of youth and parent dietary intake at six and four time points, respectively. Food prices were obtained from two online supermarkets common to the study location. Daily diet cost was calculated by summing prices of reported foods.

STATISTICAL ANALYSES PERFORMED

Random effects models estimated treatment group differences in time-varying diet cost. Separate models for youth and parent adjusted for covariates examined associations of time-varying change in diet quality with change in diet cost.

RESULTS

There was no treatment effect on time-varying diet cost for either youth (β -.49, 95% CI -1.07 to 0.08; P=0.10) or parents (β .24, 95% CI -1.61 to 2.08; P=0.80). In addition, time-varying change in diet quality indicators was not associated with time-varying change in diet cost for youth. Among parents, a 1-cup or 1-oz equivalent increase in whole plant food density was associated with a $0.63/day lower diet cost (β -.63, 95% CI -1.20 to -0.05; P=0.03).

CONCLUSIONS

Improved diet quality was not accompanied by greater cost for youth with type 1 diabetes and their parents participating in a randomized clinical trial. Findings challenge the prevailing assumption that improving diet quality necessitates greater cost.

A Systematic Review of the Impact of Multi-Strategy Nutrition Education Programs on Health and Nutrition of Adolescents

OBJECTIVE

To update evidence on the impact of multi-strategy nutrition education interventions on adolescents' health and nutrition outcomes and behaviors.

DESIGN

Systematic review of randomized controlled studies of multi-strategy interventions encompassing nutrition education published from 2000 to 2014 guided by the Preferred Reported Items for Systematic Reviews and Meta-analyses statement.

SETTING

Secondary schools in developed countries.

PARTICIPANTS

Adolescents aged 10-18 years.

MAIN OUTCOME MEASURES

Anthropometric and dietary intake.

ANALYSIS

Systematic search of 7,009 unduplicated articles and review of 11 studies (13 articles) meeting inclusion criteria using qualitative comparison.

RESULTS

Four studies reported significant changes in anthropometric measures and 9 showed significant changes in dietary intake. Type of nutrition education varied. Components of the interventions that showed statistically significant changes in anthropometric and dietary intake included facilitation of the programs by school staff and teachers, parental involvement, and using theoretical models to guide the intervention's development. Changes in canteens, food supply, and vending machines were associated with significant changes in dietary intake.

CONCLUSIONS AND IMPLICATIONS

Multi-strategy interventions can have significant impacts on nutrition of adolescents when the nutrition education is theoretically based and facilitated by school staff in conjunction with parents and families, and includes changes to the school food environment.

Quality of life, sleepiness and depressive symptoms in adolescents with insomnia: A cross-sectional study

Objectives

To determine the prevalence of insomnia in a sample of Portuguese adolescents and assess its repercussions on HRQoL, daytime sleepiness and depressive symptomatology.

Design

We carried out a cross-sectional school-based study evaluating students from Viseu.

Location

Students from twenty-six public secondary schools in the county of Viseu, Portugal.

Participants

Of 9237 questionnaires distributed, 7581 were collected (82.1%). We excluded from analysis all questionnaires from adolescents younger than 12 or older than 18 years of age (211) and unfilled forms (451). The sample comprised 6919 adolescents, the 7th to 12th grade, from 26 public secondary schools.

Interventions

None.

Measurements

Data gathering was done using a self-applied questionnaire. Insomnia was defined based on the Diagnostic and Statistical Manual of Mental Disorders – IV criteria. HRQoL was evaluated with the Quality of Life Health Survey SF-36, depressive symptomatology with BDI-II and daytime sleepiness with the Epworth Sleepiness Scale.

Results

Prevalence of insomnia was 8.3% and the prevalence of adolescents with symptoms of insomnia without daytime impairment (disturbed sleepers) was 13.1%. HRQoL was significantly reduced among adolescents with insomnia compared to normal sleepers (p < 0.001) and even when compared to disturbed sleepers (p < 0.001). There was an increase in daytime sleepiness from normal sleepers to disturbed sleepers and to adolescents with insomnia (p < 0.001). There was also an increase in the prevalence and severity of depressive symptoms (p < 0.001).

Conclusions

Our results show that insomnia is associated with a significantly lower health related quality of life among adolescents.

NutriBee Intervention Improves Diet and Psychosocial Outcomes by Engaging Early Adolescents from Diverse and Disadvantaged Communities

OBJECTIVE

NutriBee was the first clinical nutrition intervention designed to bring the Institute of Medicine recommendations for 20 hours of experiential nutrition-themed learning to grades 4-7 into club and camp settings. We piloted NutriBee to assess acceptability and impact among early adolescents in diverse and disadvantaged communities in order to evaluate its future potential as a group medical nutrition intervention.

METHODS

Nine communities across Guam, Maryland, Michigan, and New Mexico representing South Pacific Island, American Indian, urban African American, recently immigrated Hispanic, and rural Caucasian ethnic groups piloted NutriBee in nonclinical settings (clubs, schools, camps). The 6 club and camp pilots administered consenting NutriBee participants a 41-question pre-post survey assessing impact on food selection and the psychosocial parameters of intentions, outcome expectations, self-efficacy, and knowledge. Process measures included dose, fidelity, and acceptability questions.

RESULTS

Pre- and postsurveys were completed by 170 of 179 (95%) consenting, eligible participants. Impact scores increased significantly (p < 0.001): Food selection behavior (+9.3%), intentions (+19.1%), outcome expectations (+15.1%), self-efficacy (+7.4%), and knowledge (+17.6%). Each pilot (n = 6) demonstrated significant (p < 0.001) impact, a mean dose delivered of 80% (16 hours) or higher, and an acceptability score of at least 74%. Girls participating in girl-only programs (n = 72) shared greater impact than girls in coed programs (n = 41; 13.6% vs. 10.4% mean score increase, p = 0.05).

CONCLUSIONS

NutriBee successfully extended the impact of an IOM-aligned intervention to club and camp settings to which clinicians can refer at-risk early adolescents.

Care Partnerships: Toward Technology to Support Teens' Participation in Their Health Care

Adolescents with complex chronic illnesses, such as cancer and blood disorders, must partner with family and clinical caregivers to navigate risky procedures with life-altering implications, burdensome symptoms and lifelong treatments. Yet, there has been little investigation into how technology can support these partnerships. We conducted 38 in-depth interviews (15 with teenage adolescents with chronic forms of cancer and blood disorders, 15 with their parents, and eight with clinical caregivers) along with nine non-participant observations of clinical consultations to better understand common challenges and needs that could be supported through design. Participants faced challenges primarily concerning: 1) teens' limited participation in their care, 2) communicating emotionally-sensitive information, and 3) managing physical and emotional responses. We draw on these findings to propose design goals for sociotechnical systems to support teens in partnering in their care, highlighting the need for design to support gradually evolving partnerships in care.

Children's school-breakfast reports and school-lunch reports (in 24-h dietary recalls): conventional and reporting-error-sensitive measures show inconsistent accuracy results for retention interval and breakfast location

Validation-study data were analysed to investigate retention interval (RI) and prompt effects on the accuracy of fourth-grade children's reports of school-breakfast and school-lunch (in 24-h recalls), and the accuracy of school-breakfast reports by breakfast location (classroom; cafeteria). Randomly selected fourth-grade children at ten schools in four districts were observed eating school-provided breakfast and lunch, and were interviewed under one of eight conditions created by crossing two RIs ('short'--prior-24-hour recall obtained in the afternoon and 'long'--previous-day recall obtained in the morning) with four prompts ('forward'--distant to recent, 'meal name'--breakfast, etc., 'open'--no instructions, and 'reverse'--recent to distant). Each condition had sixty children (half were girls). Of 480 children, 355 and 409 reported meals satisfying criteria for reports of school-breakfast and school-lunch, respectively. For breakfast and lunch separately, a conventional measure--report rate--and reporting-error-sensitive measures--correspondence rate and inflation ratio--were calculated for energy per meal-reporting child. Correspondence rate and inflation ratio--but not report rate--showed better accuracy for school-breakfast and school-lunch reports with the short RI than with the long RI; this pattern was not found for some prompts for each sex. Correspondence rate and inflation ratio showed better school-breakfast report accuracy for the classroom than for cafeteria location for each prompt, but report rate showed the opposite. For each RI, correspondence rate and inflation ratio showed better accuracy for lunch than for breakfast, but report rate showed the opposite. When choosing RI and prompts for recalls, researchers and practitioners should select a short RI to maximise accuracy. Recommendations for prompt selections are less clear. As report rates distort validation-study accuracy conclusions, reporting-error-sensitive measures are recommended.

Can the BASNEF Model Help to Develop Self-Administered Healthy Behavior in Iranian Youth?

Background:

The stage of youth is critical for human development in several ways. On the one hand, it can lead people towards the adoption of a healthy lifestyle during adulthood based on these earlier practices. On the other hand, it can comprise the development of healthy living practices later on in live, an outcome which is often caused by the youth adopting a risky lifestyle early on.

Objectives:

The primary objective of this study was to determine the effectiveness of implementing an educational intervention program based on the BASNEF Model (a simplified approach to understanding behavior), designed to cultivate self-administered lifestyle control skills in youths.

Materials and Methods:

This was a quasi-experimental intervention study, implemented during 2010 - 2011. A total of 288 randomly selected high-school students between the ages of 15 and 17 participated in this study. These students were later divided into experimental and control groups. Subjects completed a BASNEF questionnaire at the baseline (pre-test), one month later (post-test) and three months after the educational intervention (follow-up). Four educational sessions were held, each of a 120 - 150 minute duration. After the data had been collected, the ANOVA test was used to compare trends in changes. The Pearson correlation coefficient was then used to analyze the correlation between components of the BASNEF model. Finally, regression analysis was used to determine the predictive power of the study.

Results:

Results from the intervention study reveal that the beliefs and attitudes about nutrition of the intervention group, calculated in terms of scores, improved significantly for both male and female subjects (P < 0.001) as compared to the control group. The mean BASNEF scores for improvements in beliefs among girls and boys were 79.2% and 70.1%, respectively and for attitudes, 61.2% and 59.4%. The increase was significantly higher in the intervention group (P < 0.001). Furthermore, participation in physical activity was more frequent among members of the intervention group than among those in the control group (P < 0.001).

Conclusions:

The BASNEF model could be effective in encouraging the adoption of nutritious eating habits and more active lifestyles at an early age in order to foster long-term health and well-being.

Intervention Mapping to Adapt Evidence-Based Interventions for Use in Practice: Increasing Mammography among African American Women

This paper describes and demonstrates the use of the systematic planning process, Intervention Mapping, to adapt an evidence-based public health intervention (EBI). We used a simplified version of Intervention Mapping (IM Adapt) to increase an intervention's fit with a new setting and population. IM Adapt guides researchers and practitioners in selecting an EBI, making decisions about whether and what to adapt, and executing the adaptation while guarding the EBI's essential elements (those responsible for effectiveness). We present a case study of a project in which we used IM Adapt to find, adapt, implement, and evaluate an EBI to improve mammography adherence for African American women in a new practice setting in Houston, Texas. IM Adapt includes the following (1) assess needs and organizational capacity; (2) find EBIs; (3) plan adaptations based on fit assessments; (4) make adaptations; (5) plan for implementation; and (6) plan for evaluation of the adapted EBI. The case study shows an example of how public health researchers and practitioners can use the tool to make it easier to find and use EBIs, thus encouraging greater uptake. IM Adapt adds to existing dissemination and adaptation models by providing detailed guidance on how to decide on effective adaptation, while maintaining the essential elements of the EBI.