A family-based intervention to increase fruit and vegetable consumption in adolescents: a pilot study

The effect of nutritional education based on the health action process approach (HAPA) on the pregnancy outcomes among malnourished pregnant mothers

OBJECTIVE

To examine the effectiveness of nutritional education based on the health action process approach (HAPA) on pregnancy outcomes among malnourished pregnant mothers utilizing nutritional support.

METHODS

In a randomized controlled trial, 234 malnourished pregnant women under nutritional support from the fourth month of pregnancy participated. Participants were randomly allocated in study groups by the balance block randomization method. Data were collected using a socio-demographic and pregnancy outcomes checklist as well as self-devised questionnaire assessing the constructs of the HAPA model before and three months after the educational intervention. The framework of the educational intervention was based on the constructs of the HAPA and included three one-hour training sessions through lectures, group discussions, 'question and answer' sessions, and the use of educational tools. Data were analyzed using analysis of covariance (ANCOVA) and SPSS software.

RESULTS

Pregnancy outcomes including optimal weight gain during pregnancy (p = 0.47), neonate's birth weight (p = 0.58), gestational age at delivery (p = 0.83), type of delivery (p = 0.48) gestational anemia (p = 0.22), diabetes (p = 0.59) and hypertension (p = 0.29) were not significantly different in the intervention and control groups. The results showed that the educational intervention produced a significant increase in the total score (24 points) in the intervention group. Improvement of scores in the intervention group compared to the control was observed in all of the model constructs except outcome expectation (0.68 decrease). The educational intervention in the present study had a large measure of effect in total (SMD: 2.69, partial eta2: 0.664).

CONCLUSION

A nutritional education intervention based on the HAPA model for malnourished pregnant women increased behavioral intention and planning for action to have better nutritional behavior. However, the intervention did not change the pregnancy outcomes significantly.

PRACTICE IMPLICATIONS

Nutritional education based on the HAPA model can be used to improve nutritional behaviors of malnourished pregnant women.

Improving Children's Lifestyle and Quality of Life through Synchronous Online Education: The Nutritional Adventures School-Based Program

The early introduction of effective nutritional educational programs is pivotal for instilling sustainable healthy behaviors. The present work aims to present a best practice example of a nutrition and overall lifestyle school-based training program, the Nutritional Adventures ("Diatrofoperipeteies"). Conducted during 2020-2022 in Greek primary schools, this synchronous, online educational initiative included two 1-school-hour activities with a nutrition instructor. Additionally, schools were randomly assigned to supplementary "at-home" supported-by-parents or "in-class" supported-by-educators educational activities. In total, n = 12,451 students of 84 primary schools participated. Parent-completed questionnaires were selected in the recruitment and post-intervention phase (40% participation rate); overall, the working sample was n = 1487 students. In the post-intervention phase, a significant increase in Mediterranean diet adherence was observed (KIDMED score: mean increment = 0.25 units; p < 0.001), particularly fruit and vegetable consumption. Time spent on physical activity increased, while screen time decreased. Students' total quality of life significantly improved (PedsQL; mean increment = 1.35 units; p < 0.001), including on all of its subscales (physical, emotional, social, and school function). Supplementary educational activities that were supported by educators rather than parents yielded a more favorable impact on students' lifestyle and quality of life. The Nutritional Adventures program can be regarded as a successful initiative in primary schools, yielding immediate advantages that extend beyond promoting healthy dietary habits.

Validation of the FRESH Austin food frequency questionnaire using multiple 24-h dietary recalls

OBJECTIVE

The purpose of the current study was to examine the validity of an FFQ utilised in the Food Retail: Evaluating Strategies for a Healthy Austin (FRESH Austin) study, designed to evaluate changes in the consumption of fruits and vegetables (FV) in diverse low-income communities in Austin, TX.

DESIGN

The FRESH Austin FFQ was validated against three 24-h dietary recalls (24hDR). All dietary assessments were administered (in-person or by telephone) by trained investigators.

SETTING

Recruitment was conducted at sites within the geographic areas targeted in the FRESH Austin recruitment. People at a community health clinic, a local health centre and a YMCA within the intervention area were approached by trained and certified data collectors, and invited to participate.

PARTICIPANTS

Among fifty-six participants, 83 % were female, 46 % were non-White, 24 % had income < $25 K/year and 30 % spoke only/mostly Spanish at home.

RESULTS

The FFQ and average of three 24hDR produce similar estimates of average total servings/d across FV (6·68 and 6·40 servings/d, respectively). Correlations produced measures from 0·01 for 'Potatoes' and 0·59 for 'Other Vegetables'. Mean absolute percentage errors values were small for all FV, suggesting the variance of the error estimates was also small. Bland-Altman plots indicate acceptable levels of agreement between the two methods.

CONCLUSION

These outcomes indicate that the FRESH FFQ is a valid instrument for assessing FV consumption. The validation of the FRESH Austin FFQ provides important insights for evaluating community-based efforts to increase FV consumption in diverse populations.

Trends in the Number of Behavioural Theory-Based Healthy Eating Interventions Inclusive of Dietitians/Nutritionists in 2000-2020

Nutrition interventions developed using behaviour theory may be more effective than those without theoretical underpinnings. This study aimed to document the number of theory-based healthy eating interventions, the involvement of dietitians/nutritionists and the behaviour theories employed from 2000 to 2020. We conducted a review of publications related to healthy eating interventions that used behaviour change theories. Interventional studies published in English between 2000 and 2020 were retrieved from searching Medline, Cinahl, Embase, Psycinfo and Cochrane Central. Citation, country of origin, presence or absence of dietitian/nutritionist authors, participants, dietary behaviours, outcomes, theories and any behaviour change techniques (BCTs) stated were extracted. The publication trends on a yearly basis were recorded. A total of 266 articles were included. The number of theory-based interventions increased over the two decades. The number of studies conducted by dietitians/nutritionists increased, but since 2012, increases have been driven by other researchers. Social cognitive theory was the most used behaviour theory. Dietitians/nutritionists contributed to growth in publication of theory-based healthy eating interventions, but the proportion of researchers from other professions engaged in this field increased markedly. The reasons for this growth in publications from other professions is unknown but conjectured to result from greater prominence of dietary behaviours within the context of an obesity epidemic.

An online family-based self-monitoring and goal-setting intervention to improve children’s physical activity: the FRESH feasibility trial and three-arm pilot RCT

Background

Family-based physical activity promotion presents a promising avenue for promoting whole-family physical activity, but high-quality research is lacking.

Objectives

To assess the feasibility, acceptability and preliminary effectiveness of FRESH (Families Reporting Every Step to Health), a child-led online family-based physical activity intervention; and to identify effective and resource-efficient family recruitment strategies.

Design

The project consisted of (1) a randomised feasibility trial, (2) a randomised controlled pilot trial and (3) a systematic review and Delphi study.

Setting

Norfolk/Suffolk counties, UK.

Participants

Families, recruited from schools, workplaces and community settings, were eligible to participate if one child aged 7–11 years and one adult responsible for their care provided written consent; all family members could participate.

Interventions

The FRESH intervention, guided by self-determination theory, targeted whole families and was delivered via an online platform. All family members received pedometers and were given website access to select family step challenges to ‘travel’ to target cities around the world, log steps, and track progress as they virtually globetrotted. Families were randomised to FRESH intervention, pedometer-only or control arm.

Main outcome measures

Physical (e.g. blood pressure), psychosocial (e.g. family functioning) and behavioural (e.g. device-measured family physical activity) measures were collected at baseline and at 8- and 52-week follow-up. A mixed-methods process evaluation assessed the acceptability of the intervention and evaluation.

Data sources review

Systematic search of four databases (Cochrane Library, PubMed, PsycINFO and SCOPUS).

Review methods

Articles were screened in duplicate, and data extraction was fully checked. Academic experts participated in the three-round Delphi study. Data were combined to identify effective and resource-efficient family recruitment strategies.

Inclusion criteria

Included generally healthy school-aged children and at least one adult; intervention attempted to change physical activity, sedentary behaviour, screen use, diet, or prevent overweight/obesity in multiple family members; presented relevant measure of effect in children and adults.

Results

The feasibility study (12 families, 32 participants; 100% retention at 8 weeks) demonstrated the feasibility and acceptability of FRESH, but highlighted that adaptations were required. Of 41 families recruited in the pilot study (149 participants), 98% and 88% were retained at the 8-week and 52-week follow-up, respectively. More children in the FRESH arm self-reported doing more family physical activity, and they thought that FRESH was fun. There were no notable between-group differences in children’s outcomes. Change in moderate to vigorous physical activity at 8 weeks favoured FRESH intervention adults [vs. control: 9.4 minutes/week (95% confidence interval 0.4 to 18.4) vs. pedometer only: 15.3 (95% confidence interval 6.0 to 24.5)], and was stronger in fathers, but this was not maintained. In 49 included studies, apart from recruitment settings and strategies used (reported in 84% and 73% of the studies, respectively), recruitment details were scarce. School-based recruitment was predominant. The Delphi study identified a wide range of recruitment settings and strategies.

Limitations

Recruitment was the main limitation of the FRESH studies; generalisability of the proposed recruitment strategies may be limited.

Conclusions

This study has demonstrated the feasibility and acceptability of the FRESH intervention. However, we failed to recruit the target sample size and were unable to demonstrate a signal of effectiveness. Future research should employ a multifaceted recruitment approach.

Future work

Further refinements to intervention delivery and recruitment methods should be investigated.

Study registration

Current Controlled Trials ISRCTN12789422 and PROSPERO CRD42019140042.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.

Impact of a Series of Educational Talks Taught by Health Professionals to Promote Healthy Snack Choices among Children

BACKGROUND

One of the great challenges facing today's society is the need to combat overweight and obesity in schoolchildren. This study aimed to analyze the impact of a cycle of didactic talks-given to families by a specialist in pediatrics, a specialist in nutrition and dietetics and a specialist in physical exercise-on childrens' snack choices and nutrition quality.

METHODS

A longitudinal, quasi-experimental and quantitative investigation was designed, working with a total sample of 50 students divided into control and experimental groups. The nutritional quality of daily snacks was recorded during the month before and the month after the cycle of talks given by health experts.

RESULTS

An increase in the nutritional quality of the snacks was observed in the days after the talk-but, after a week, values returned to normal.

CONCLUSIONS

The giving of educational talks to promote healthy habits may have a positive impact on the nutritional quality of school snacks in the days immediately following the talks. However, some forgetfulness was detected over time, which reduced the nutritional quality of the snacks once more. For future work, it is recommended that researchers measure the impact produced by giving regular talks.

Effectiveness of a nutrition education and intervention programme on nutrition knowledge and dietary practice among Princess Nourah Bint Abdulrahman University's population

OBJECTIVE

The study sought to assess the influence of nutrition education and intervention programmes on nutrition knowledge and dietary practice among both students and staff (including faculty) of Princess Nourah Bint Abdulrahman University in Saudi Arabia.

DESIGN

A pretest-posttest, non-randomised experimental study design was implemented at Princess Nourah Bint Abdulrahman University in Riyadh City between September 2019 and February 2020.

SETTING

Princess Nourah Bint Abdulrahman University is the largest women's university in the world and has eighteen colleges and institutions and around ninety academic programmes.

PARTICIPANTS

The survey was completed by 1824 participants (1350 students and 474 staff/faculty) before the intervention and by a different cohort of 1731 participants (1317 students and 414 staff/faculty) after the intervention. In total, an independent sample of 3555 staff and students participated. Participants were asked about dietary knowledge and practices. Dietary knowledge entailed food variety and nutrients, fast food and its poor nutritional value, and the influence of cooking style on the nutritional quality of food. Dietary practices involved eating breakfast; consuming salt/sugar, eating high-salt food; eating pre-packaged food and consumption of vegetables, fruits, supplements, water and caffeine.

RESULTS

The majority of the sample consisted of students (75·1 %) and had not been diagnosed with any disease (73·7 %). The result of the current study showed that nutrition knowledge improved after completion of the nutrition programme.

CONCLUSIONS

The nutrition awareness programme improved students' nutritional knowledge; however, there was no significant effect on their dietary practices. Future nutrition awareness programmes should separate activities for students and staff, focusing on one target population at a time.

Predictors of mothers’ performance in daily use of five servings of fruit and vegetables by rural preschoolers

Purpose

Using the PRECEDE model, the purpose of this paper is to determine the predictors of mothers’ performance in daily consumption of fruit and vegetables (FV) in rural preschoolers.

Design/methodology/approach

This study was carried out on 350 mothers of preschool children who had health records in the rural health-care centers of Iran. To collect data, a researcher-made questionnaire based on the PRECEDE model was used. The data were analyzed using the SPSS 19 software.

Findings

The results showed that 11.42 percent of the mothers observed the FV intake for their children recommended by WHO. The independent t-test showed a significant difference between the mean scores of predisposing, enabling and reinforcing factors.

Originality/value

This study showed that the rate of FV intake by preschool children in rural areas was much lower than the recommended WHO rate. To promote behavior, attention to the predisposing, enabling and reinforcing factors seems to be necessary.

Healthy eating interventions delivered in the family home: A systematic review

Unhealthy eating habits have long term health implications and can begin at a young age when children still consume the majority of their meals at home. As parents are the principal agents of change in children's eating behaviours, the home environment is the logical location for the delivery of interventions targeting healthy family eating. Despite the recent proliferation of published studies of behaviour-change interventions delivered in the home, there has been little attempt to evaluate what makes such interventions successful. This review provides a systematic evaluation of all healthy eating interventions delivered to families in the home environment to date and seeks to identify the successful elements of these interventions and make recommendations for future work. Thirty nine studies are described, evaluated and synthesised. Results show that evidence- and theory-based interventions tended to be more successful than those that did not report detailed formative or evaluative work although details of theory application were often lacking. Careful analysis of the results did not show any further systematic similarities shared by successful interventions. Recommendations include the need for more clearly theoretically driven interventions, consistent approaches to measuring outcomes and clarity regarding target populations and desired outcomes.

Effectiveness of the Nutritional App "MyNutriCart" on Food Choices Related to Purchase and Dietary Behavior: A Pilot Randomized Controlled Trial

Objective: To pilot test the effectiveness of “MyNutriCart”, a smartphone application (app) that generates healthy grocery lists, on diet and weight. Methods: A pilot randomized trial was conducted to test the efficacy of using the “MyNutriCart” app compared to one face-to-face counseling session (Traditional group) in Hispanic overweight and obese adults. Household food purchasing behavior, three 24-h food recalls, Tucker’s semi-quantitative food frequency questionnaire (FFQ), and weight were assessed at baseline and after 8 weeks. Statistical analyses included t tests, a Poisson regression model, and analysis of covariance (ANCOVA) using STATA. Results: 24 participants in the Traditional group and 27 in the App group completed the study. Most participants were women (>88%), with a mean age of 35.3 years, more than a high school education (>80%), a family composition of at least three members, and a mean baseline body mass index (BMI) of 34.5 kg/m². There were significant improvements in household purchasing of vegetables and whole grains, in individual intakes of refined grains, healthy proteins, whole-fat dairies, legumes, 100% fruit juices, and sweets and snacks; and in the individual frequency of intake of fruits and cold cuts/cured meats within the intervention group (p < 0.05). However, no significant differences were found between groups. No changes were detected in weight. Conclusions: “MyNutriCart” app use led to significant improvements in food-related behaviors compared to baseline, with no significant differences when compared to the Traditional group. Cost and resource savings of using the app compared to face-to-face counseling may make it a good option for interventionists.

A Systematic Review of Digital Interventions for Improving the Diet and Physical Activity Behaviors of Adolescents

Many adolescents have poor diet and physical activity behaviors, which can lead to the development of noncommunicable diseases in later life. Digital platforms offer inexpensive means of delivering health interventions, but little is known about their effectiveness. This systematic review was conducted to synthesize evidence on the effectiveness of digital interventions to improve diet quality and increase physical activity in adolescents, to effective intervention components and to assess the cost-effectiveness of these interventions. Following a systematic search, abstracts were assessed against inclusion criteria, and data extraction and quality assessment were performed for included studies. Data were analyzed to identify key features that are associated with significant improvement in behavior. A total of 27 studies met inclusion criteria. Most (n = 15) were Web site interventions. Other delivery methods were text messages, games, multicomponent interventions, emails, and social media. Significant behavior change was often seen when interventions included education, goal setting, self-monitoring, and parental involvement. None of the publications reported cost-effectiveness. Due to heterogeneity of studies, meta-analysis was not feasible.It is possible to effect significant health behavior change in adolescents through digital interventions that incorporate education, goal setting, self-monitoring, and parental involvement. Most of the evidence relates to Web sites and further research into alternate media is needed, and longer term outcomes should be evaluated. There is a paucity of data on the cost-effectiveness of digital health interventions, and future trials should report these data.

A cluster randomised controlled trial of an intervention based on the Health Action Process Approach for increasing fruit and vegetable consumption in Iranian adolescents

OBJECTIVE

To evaluate an intervention programme based on the Health Action Process Approach and designed to increase the intake of fruit and vegetables (F&V) among Iranian adolescents aged 13 to 18.

DESIGN

A randomised controlled trial with three arms examined the short- (1 month) and long-term (6 months) effects of the intervention. There were two intervention groups (one included adolescents only [A group; n = 510]; the second included mothers and adolescents [M + A group; n = 462]) and a control group (n = 483). All participants were recruited from schools.

MAIN OUTCOME MEASURES

Social cognitions, self-regulatory processes and F&V intake.

RESULTS

The intervention led to an increase in F&V intake for adolescents in the short and long terms. Adolescents in the M + A group increased their F& V intake more than adolescents in the A group. Outcome expectancies, self-monitoring, intentions, action and coping planning, perceived social support and behavioural automaticity mediated the effect of the intervention on F&V intake.

CONCLUSION

The theory-based intervention led to an increase in F&V intake and promoted more positive social cognitions and self-regulatory processes among Iranian adolescents. The findings also provide evidence that involving mothers in an intervention can confer additional benefit.

Percentage of Youth Meeting Federal Fruit and Vegetable Intake Recommendations, Youth Risk Behavior Surveillance System, United States and 33 States, 2013

BACKGROUND

National- and state-level self-reported frequency of fruit and vegetable (F/V) consumption is available for high school students from the Centers for Disease Control and Prevention's Youth Risk Behavior Surveillance System (YRBSS). YRBSS monitors priority health-risk behaviors among a nationally representative sample of US high school students and representative samples of students in states and selected large urban school districts. However, YRBSS measures intake in times per day and not the cup equivalents that national goals use, which limits interpretation.

OBJECTIVE

To help states track youth progress, scoring algorithms were developed from external data and applied to 2013 YRBSS data to estimate the percentages of high school students in the nation and 33 states meeting the US Department of Agriculture's Food Patterns F/V intake recommendations.

DESIGN

Twenty-four-hour dietary recalls were used from the 2007-2010 National Health and Nutrition Examination Survey to fit sex-specific models for 14- to 18-year-olds that estimate probabilities of meeting recommendations as a function of reported frequency of consumption and race/ethnicity, adjusting for day-to-day dietary variation. Model regression parameters were then applied to national cross-sectional YRBSS data (n=12,829) and to data from the 33 states (n=141,006) that had complete F/V data to estimate percentages meeting recommendations.

RESULTS

Based on the prediction equations, 8.5% of high school students nationwide met fruit recommendations (95% CI 4.9% to 12.1%) and 2.1% met vegetable recommendations (95% CI 0.0% to 8.1%). State estimates ranged from 5.3% in Nebraska and Missouri to 8.9% in Florida for fruit and 1.0% in New Jersey, North Dakota, and South Carolina to 3.3% in New Mexico for vegetables.

CONCLUSIONS

This method provides a new tool for states to track youth progress toward meeting dietary recommendations and indicates that a high percentage of youth in all states examined have low intakes of F/V.

Creating a student-led health magazine with an urban, multicultural, resource-restricted elementary school: Approach, process and impact

BACKGROUND

Health magazines effectively deliver health information. No data regarding student-led magazines to promote health exist.

OBJECTIVE

To evaluate whether children's health knowledge, interests and lifestyle choices improve following distribution of a student-led health magazine.

METHODS

Elementary students worked with teachers and paediatric residents to publish a health magazine. A healthy lifestyle challenge page promoted reduction in soda pop consumption. Pre- and poststudent questionnaires explored knowledge, interests and behaviours related to health.

RESULTS

Sex and grade distributions were similar in pre- and post-questionnaires. Ninety-seven percent of children reported the magazine helped them learn about health. Pre- and postknowledge scores did not differ (P=0.36). Following distribution, the percentage of students who reported drinking no soda increased from 43% to 67% (P=0.004), and those who reported drinking <2 glasses of soda per day increased from 66% to 85% (P=0.01).

CONCLUSIONS

A student-led health magazine was effective in motivating short-term student-reported behavioural change.

Process Evaluation of the Project SHINE Intervention for African American Families: An Integrated Positive Parenting and Peer Monitoring Approach to Health Promotion

This study describes the process evaluation of Project SHINE, a randomized family-based health promotion intervention that integrated parenting and peer monitoring for improving sedentary behavior, physical activity, and diet in African American families. Adolescent-parent dyads (n = 89) were randomized to a 6-week behavioral, positive parenting, and peer monitoring skills intervention or a general health education comparison condition. Process evaluation included observational ratings of fidelity, attendance records, psychosocial measures, and qualitative interviews. Results indicated that the intervention was delivered with high fidelity based on facilitator adherence (>98% of content delivered) and competent use of theoretically based behavior change and positive parenting skills (100% of ratings >3 on a 1-4 scale). Although only 43% of peers attended the "bring a friend" session, overall attendance was high (4.39 ± 1.51 sessions) as was the retention rate (88%). Parents in the intervention condition reported significant improvements in communication related to adolescents' engagement in health behaviors both on their own and with peers. These findings were supported by qualitative themes related to improvements in family communication and connectedness. This study provides an innovative example of how future family-based health promotion trials can expand their process evaluation approaches by assessing theoretically relevant positive parenting variables as part of ongoing monitoring.

An online tool for obesity intervention and public health

BACKGROUND

Though the United States of America (U.S.A.) obesity rate shows signs of leveling off, rates remain high. Poor nutrition contributes to the development of obesity, and physical inactivity is an important cause of numerous diseases and directly linked to obesity. Efforts to improve diet, increase physical activity and pursue other behavioral changes seem imperative. However, the effective management of intervention strategies for large number of participants are challenging because services in primary, secondary, and tertiary cares are often under-resourced, relatively uncoordinated with other parts of the health system. It is thus necessary to have accompanying intervention strategies that can be carried out at population level. In this paper, we describe an online intervention tool designed for the Obesity Prevention Tailored for Health II project to help achieve such goals.

RESULTS

The first part of the online tool locates healthy food stores and recreational programs within a specified distance of a participant's home or a place of interest. The food environments include fruit & vegetable stores, farmers' markets and grocery stores, and the companying popup window shows the street address and contact information of each store. The parks and recreational programs are displayed on names of park or recreational program, types of program available, and city each amenity belongs to. The tool also provides spatial coverage of vegetation greenness, air pollution and of historical traffic accidents involving active travel. The second part of the tool provides optimized travel options for reaching various amenities. By incorporating bicycling, walking and public transit into the trip planner, this online tool helps increase active transport and reduce dependence on automobiles. It promotes transportation that encourages safety awareness, physical activity, health, recreation, and resource conservation.

CONCLUSIONS

We developed the first Google-based online intervention tool that assists obese and overweight participants in finding food and recreational amenities around locations of interest and identifying optimized routes that fit their personal preferences. This tool can also serve general public and policy makers for education, disease prevention and health promotion.

Nutrition promotion approaches preferred by Australian adolescents attending schools in disadvantaged neighbourhoods: a qualitative study

Background

Links between socioeconomic disadvantage and unhealthy eating behaviours among adolescents are well established. Little is known about strategies that might support healthy eating among this target group. This study aimed to identify potential strategies and preferred dissemination methods that could be employed in nutrition promotion initiatives focussed on improving eating behaviours among socioeconomically disadvantaged adolescents.

Methods

Semi-structured interviews were conducted in 2011 among 22 adolescents (12–15 years) recruited from secondary schools in disadvantaged neighbourhoods in Victoria, Australia.

Results

Strategies suggested by adolescents to support healthy eating included increasing awareness about healthy eating; greater cooking involvement; greater parental and peer support; frequent family meal participation; greater parental and peer role-modelling of healthy eating; increased availability of healthy foods and decreased availability of unhealthy foods in homes and schools. Adolescents preferred electronic media, adolescent-specific recipe books, and school-based methods for distributing nutrition promotion messages and strategies.

Conclusions

A number of suggested strategies and methods identified in the present investigation have been employed with success in previous nutrition promotion interventions targeting socioeconomically disadvantaged adolescents. The present study also contributes novel insights into potential strategies and methods that could be employed in initiatives aiming to improve eating behaviours in this vulnerable group, and particularly highlights the importance of incorporating strategies involving parents and modifying the home food environment.

Putting habit into practice, and practice into habit: a process evaluation and exploration of the acceptability of a habit-based dietary behaviour change intervention

Background

Forming ‘habit’ – defined as a learned process that generates automatic responses to contextual cues – has been suggested as a mechanism for behaviour maintenance, but few studies have applied habit theory to behaviour change. This study used process evaluation data, taken from a randomised controlled trial of a healthy child-feeding intervention for parents previously shown to be effective, to explore the applicability to dietary behaviour change of predictions and recommendations drawn from habit theory. The intervention supported parents in pursuing child-feeding habit goals in three domains (giving fruit and vegetables, water, healthy snacks), over four fortnightly home visits. We explored whether (a) the habit-formation model was acceptable to participants, (b) better-specified habit-formation goals yielded greater habit gains, and (c) habit gains were sustained (d) even when subsequent, new habit goals were pursued.

Methods

Qualitative and quantitative data were taken from 57 parents randomised to the intervention arm, and so analyses presented here used a pre-post intervention design. Thematic analysis of post-intervention qualitative interviews evaluated acceptability, and self-reported habit goals were content-analysed. ANOVAs explored changes in habit strength, recorded at home visits and one- and two-month follow-ups, across time and goals.

Results

Participants understood and engaged positively with the habit-formation approach. Although many seemingly poorly-specified habit goals were set, goal characteristics had minimal impact on habit strength, which were achieved within two weeks for all behaviours (p’s < .001), and were maintained or had increased further by the final follow-up.

Conclusions

The habit-formation model appears to be an acceptable and fruitful basis for dietary behaviour change.

'On Your Feet to Earn Your Seat', a habit-based intervention to reduce sedentary behaviour in older adults: study protocol for a randomized controlled trial

Background

Many older adults are both highly sedentary (that is, spend considerable amounts of time sitting) and physically inactive (that is, do little physical activity). This protocol describes an exploratory trial of a theory-based behaviour change intervention in the form of a booklet outlining simple activities (‘tips’) designed both to reduce sedentary behaviour and to increase physical activity in older adults. The intervention is based on the ‘habit formation’ model, which proposes that consistent repetition leads to behaviour becoming automatic, sustaining activity gains over time.

Methods

The intervention is being developed iteratively, in line with Medical Research Council complex intervention guidelines. Selection of activity tips was informed by semi-structured interviews and focus groups with older adults, and input from a multidisciplinary expert panel. An ongoing preliminary field test of acceptability among 25 older adults will inform further refinement. An exploratory randomized controlled trial will be conducted within a primary care setting, comparing the tips booklet with a control fact sheet. Retired, inactive and sedentary adults (n = 120) aged 60 to 74 years, with no physical impairments precluding light physical activity, will be recruited from general practices in north London, UK. The primary outcomes are recruitment and attrition rates. Secondary outcomes are changes in behaviour, habit, health and wellbeing over 12 weeks.

Discussion

Data will be used to inform study procedures for a future, larger-scale definitive randomized controlled trial.

Trial registration

Current Controlled Trials ISRCTN47901994.

Electronic supplementary material

The online version of this article (doi:10.1186/1745-6215-15-368) contains supplementary material, which is available to authorized users.

Social-cognitive correlates of fruit and vegetable consumption in minority and non-minority youth

OBJECTIVE

Inadequate fruit and vegetable (FV) consumption signals a need for identifying predictors and correlates of intake, particularly in diverse adolescents.

DESIGN

Participants completed an on-line assessment in early 2010.

SETTING

Computer classrooms in 4 high schools.

PARTICIPANTS

One hundred twenty-two Caucasian and 125 minority (African American and Hispanic) high school students (mean age = 15.3 years, SD = 1.0) with parental consent. Response rate was 89%.

VARIABLES MEASURED

Self-efficacy as measured by confidence in goal setting and decision making about healthful eating; perceived benefits and barriers to eating FVs; healthful eating-related social support; body esteem; and FV intake.

ANALYSIS

t tests were used to examine group differences, and binary logistic regression analyses were conducted to explore the predictors of 5-A-Day FV consumption.

RESULTS

Thirty-four percent of the non-minority group and 28% of the minority group reported eating 5 or more portions of FVs a day (P = .34). Self-efficacy and perceived benefits predicted consumption in minority participants, whereas barriers and social support were significant predictors in the non-minority group.

CONCLUSIONS AND IMPLICATIONS

These findings suggest different variables predict consumption for minority and non-minority groups and that self-efficacy is an important variable to consider in dietary change programs for minority adolescents.

Community-based interventions for enhancing access to or consumption of fruit and vegetables among five to 18-year olds: a scoping review

BACKGROUND

Low fruit and vegetable ( FV) consumption is a key risk factor for morbidity and mortality. Consumption of FV is limited by a lack of access to FV. Enhanced understanding of interventions and their impact on both access to and consumption of FV can provide guidance to public health decision-makers. The purpose of this scoping review is to identify and map literature that has evaluated effects of community-based interventions designed to increase FV access or consumption among five to 18-year olds.

METHODS

The search included 21 electronic bibliographic databases, grey literature, targeted organization websites, and 15 key journals for relevant studies published up to May 2011. Retrieved citations were screened in duplicate for relevance. Data extracted from included studies covered: year, country, study design, target audience, intervention setting, intervention strategies, interventionists, and reported outcomes.

RESULTS

The search located 19,607 unique citations. Full text relevance screening was conducted on 1,908 studies. The final 289 unique studies included 30 knowledge syntheses, 27 randomized controlled trials, 55 quasi-experimental studies, 113 cluster controlled studies, 60 before-after studies, one mixed method study, and three controlled time series studies. Of these studies, 46 included access outcomes and 278 included consumption outcomes. In terms of target population, 110 studies focused on five to seven year olds, 175 targeted eight to 10 year olds, 192 targeted 11 to 14 year olds, 73 targeted 15 to 18 year olds, 55 targeted parents, and 30 targeted teachers, other service providers, or the general public. The most common intervention locations included schools, communities or community centres, and homes. Most studies implemented multi-faceted intervention strategies to increase FV access or consumption.

CONCLUSIONS

While consumption measures were commonly reported, this review identified a small yet important subset of literature examining access to FV. This is a critically important issue since consumption is contingent upon access. Future research should examine the impact of interventions on direct outcome measures of FV access and a focused systematic review that examines these interventions is also needed. In addition, research on interventions in low- and middle-income countries is warranted based on a limited existing knowledge base.

Towards parsimony in habit measurement: testing the convergent and predictive validity of an automaticity subscale of the Self-Report Habit Index

BACKGROUND

The twelve-item Self-Report Habit Index (SRHI) is the most popular measure of energy-balance related habits. This measure characterises habit by automatic activation, behavioural frequency, and relevance to self-identity. Previous empirical research suggests that the SRHI may be abbreviated with no losses in reliability or predictive utility. Drawing on recent theorising suggesting that automaticity is the 'active ingredient' of habit-behaviour relationships, we tested whether an automaticity-specific SRHI subscale could capture habit-based behaviour patterns in self-report data.

METHODS

A content validity task was undertaken to identify a subset of automaticity indicators within the SRHI. The reliability, convergent validity and predictive validity of the automaticity item subset was subsequently tested in secondary analyses of all previous SRHI applications, identified via systematic review, and in primary analyses of four raw datasets relating to energy-balance relevant behaviours (inactive travel, active travel, snacking, and alcohol consumption).

RESULTS

A four-item automaticity subscale (the 'Self-Report Behavioural Automaticity Index'; 'SRBAI') was found to be reliable and sensitive to two hypothesised effects of habit on behaviour: a habit-behaviour correlation, and a moderating effect of habit on the intention-behaviour relationship.

CONCLUSION

The SRBAI offers a parsimonious measure that adequately captures habitual behaviour patterns. The SRBAI may be of particular utility in predicting future behaviour and in studies tracking habit formation or disruption.

Implementing Heart Healthy Dietary Guidelines

Over recent decades, abundant scientific evidence has led to authoritative dietary guidelines and recommendations for heart healthy eating and lifestyle behaviors. But most children and adults do not regularly achieve these goals. Consequently, our focus must now be on helping individual patients and our communities implement these guidelines in everyday life. This article reviews current evidence for insights and practical techniques that can help individuals move from ideal goals to real practice of heart healthy nutrition and lifestyle behaviors.

Parental influences on adolescent fruit consumption: the role of adolescent self-efficacy

The aims of this study were to examine whether adolescent self-efficacy mediates the associations between parental control, perceptions of the importance of healthy nutrition for child health and barriers to buying fruits and vegetables and adolescent fruit consumption using a theoretically derived explanatory model. Data were drawn from a community-based sample of 1606 adolescents in Years 7 and 9 of secondary school and their parents, from Victoria, Australia. Adolescents completed a web-based survey assessing their fruit consumption and self-efficacy for increasing fruit consumption. Parents completed a survey delivered via mail assessing parental control, perceptions and barriers to buying fruit and vegetables. Adolescent self-efficacy for increasing fruit consumption mediated the positive associations between parental control and perceptions of the importance of healthy nutrition for child health and adolescent fruit consumption. Furthermore, adolescent self-efficacy mediated the negative association between parental barriers to buying fruits and vegetables and adolescent fruit consumption. The importance of explicating the mechanisms through which parental factors influence adolescent fruit consumption not only relates to the advancement of scientific knowledge but also offers potential avenues for intervention. Future research should assess the effectiveness of methods to increase adolescent fruit consumption by focussing on both improving adolescents' dietary self-efficacy and on targeting parental control, perceptions and barriers.

Trend in eating habits among Lithuanian school-aged children in context of social inequality: three cross-sectional surveys 2002, 2006 and 2010

Background

Intermittent monitoring of food intake at the population level is essential for the planning and evaluation of national dietary intervention programs. Social-economic changes in Lithuania have likely affected dietary habits, but only a limited number of temporal studies on food intake trends among young population groups have been published. The aim of this study was to investigate changes in eating habits among Lithuanian school-aged children from 2002 to 2010, and to explore the association of these changes with the respondents' reported socio-economic status (SES).

Methods

We used Lithuanian data from the cross-national Health Behaviour in School-aged Children (HBSC) study collected in 2002, 2006 and 2010. Analyses were conducted on comparable questionnaire-based data from children aged 11, 13 and 15 (total n = 17,189) from a random sample of schools. A food frequency questionnaire was used to investigate frequencies of food consumption. Logistic regression was used to examine the affects of changing social variables on reported diet trends.

Results

In Lithuania, school-aged children have low intakes of fruits and vegetables. Only 21.1% of boys and 27.1% of girls reported daily fruit consumption. Similarly, 24.9% of boys and 29.6% of girls disclosed vegetable intake at least once daily. Comparing 2010 to 2002, the proportion of girls who consumed fruits daily increased from 24.2% to 31.0% (p < 0.001) but the proportion of boys who consumed vegetables daily decreased from 29.3% to 23.1% (p < 0.001). In 2006, for both sexes, there were observed increases in regular (at least five days a week) intake of sweets and chocolates, biscuits and pastries, and soft drinks; however, in the next survey (2010) these figures decreased. In addition, between 2006 and 2010, a substantial decrease in regular consumption of chips and fast food was also detected. Fruit and vegetable consumption as well as intake of sweets and chocolates, biscuits and pastries and soft drinks increased with family social-economic status and family material wealth. Trends in consumption of fruits, and other foods, and their association with changing social variables were demonstrated using the ORs estimated by three logistic models, using 2002 as the reference point. Changes in social variables from 2002 to 2010 affected the likelihood of daily consumption of fruits among boys by 22.5% (the corresponding OR decreased from 1.11 to 0.86) and among girls by 34.0% (the corresponding OR decreased from 1.41 to 1.12). Over the study period, changing social variables had little impact on the daily consumption of vegetables and other foods.

Conclusions

Based on the food consumption trends observed in Lithuania, increases in consumption of fruits and vegetables should be promoted, along with a reduction in the intake of less healthy choices, such as soft drinks and high-fat, high-sugar snack foods, by diminishing social inequalities in food consumption.

Sedentary behavior and dietary intake in children, adolescents, and adults. A systematic review

CONTEXT

Sedentary behavior is implicated in youth and adult overweight and obesity. However, the relationship between sedentary behavior and weight status is often small or inconsistent, with few studies controlling for confounding factors such as diet and physical activity. Diet has been hypothesized to covary with some sedentary behaviors. It is opportune, therefore, to review whether dietary intake is associated with sedentary behavior in young people and adults. This may allow for better interpretation of the diversity of findings concerning sedentary behavior and weight status.

EVIDENCE ACQUISITION

Published English-language studies were located from computerized and manual searches in early 2010. Included studies were observational studies assessing an association between at least one sedentary behavior and at least one aspect of dietary intake in children (aged <11 years), adolescents (aged 12-18 years), or adults (aged >18 years).

EVIDENCE SYNTHESIS

Fifty-three studies, totaling 111 independent samples, were eligible for this review. Sedentary behavior in children (n=19, independent samples=24), adolescents (n=26, independent samples=72), and adults (n=11, independent samples=14) appears to be clearly associated with elements of a less healthy diet including lower fruit and vegetable consumption; higher consumption of energy-dense snacks, drinks, and fast foods; and higher total energy intake. Strengths of association were mainly in the small-to-moderate range.

CONCLUSIONS

The association drawn mainly from cross-sectional studies is that sedentary behavior, usually assessed as screen time and predominantly TV viewing, is associated with unhealthy dietary behaviors in children, adolescents, and adults. Interventions need to be developed that target reductions in sedentary time to test whether diet also changes.