Using technology to promote self-efficacy for healthy eating in adolescents

Healthy Eats-Evaluation of a Social Marketing Program Delivered in Primary School Settings in Queensland

One in four school children in Australia are overweight or obese. In response, the Healthy Eats program was developed, piloted, and delivered using a whole-of-school approach underpinned by the socio-ecological model to increase fruit and vegetable consumption among children aged 8-10 years in regional Queensland, Australia. This research presents an outcome evaluation of the Healthy Eats program using pre-post data collected throughout 2021 (cross-sectional for knowledge and longitudinal for behaviour) from 19 schools to assess whether changes occurred in students' nutritional knowledge (n = 1868 (pre = 933, post = 935)) and fruit and vegetable consumption (n = 1042 (pre = 521, post = 521)). Knowledge data was collected via self-reports two weeks prior and immediately after the Nutrition Module. Behavioural data on daily fruit and vegetable consumption was gathered via student passports (i.e., surveys) one week before and for four consecutive weeks after the Nutrition Module. Chi-Square Difference tests and t-Tests were conducted with a significance level set at p < 0.05. Across all 19 schools, knowledge of the daily recommended serves of fruit and vegetables improved significantly following participation in the program, aligning knowledge closer to the Australian dietary guidelines. Behavioural results for fruit consumption were favourable, with clear improvements reported. Increases in vegetable consumption were demonstrated in two of the eight schools. A discussion on the knowledge-action gap is provided, including recommendations for future iterations of the Healthy Eats program.

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.

Digital Interventions for Universal Health Promotion in Children and Adolescents: A Systematic Review

BACKGROUND AND OBJECTIVES

Digital media has been used mostly to deliver clinical treatments and therapies; however limited evidence evaluates digital interventions for health promotion. The objective of this review is to identify digital interventions for universal health promotion in school-aged children and adolescents globally.

METHODS

Eligible articles were searched in PubMed, Embase, Medline, Ovid SP, The Cochrane Library, Cochrane Central Register of Controlled Trials, WHO regional databases, Google Scholar, and reference lists from 2000 to March 2021. Randomized controlled trials and quasi-experimental studies evaluating interventions that promote health in school-aged children and adolescents (5-19.9 years) were included. Methods were conducted in duplicate. Where possible, data were pooled with a random-effects model.

RESULTS

Seventy-four studies were included (46 998 participants), of which 37 were meta-analyzed (19 312 participants). Interventions increased fruit and vegetable consumption (servings per day) (mean difference [MD] 0.63, 95% confidence interval [CI] 0.21 to 1.04; studies = 6; P = .003; high quality of evidence), and probably reduced sedentary behavior (MD -19.62, 95% CI -36.60 to -2.65; studies = 6; P = .02; moderate quality of evidence), and body fat percentage (MD -0.35%, 95% CI -0.63 to -0.06; studies = 5; P = .02; low quality of evidence). The majority of studies were conducted in high-income countries and significant heterogeneity in design and methodology limit generalizability of results.

CONCLUSIONS

There is great potential in digital platforms for universal health promotion; however, more robust methods and study designs are necessitated. Continued research should assess factors that limit research and program implementation in low- to middle-income countries.

Developing and validating a new scale to measure the acceptability of health apps among adolescents

Background

The acceptability of health interventions is centrally important to achieving their desired health outcomes. The construct of acceptability of mobile health interventions among adolescents is neither well-defined nor consistently operationalized.

Objectives

Building on the theoretical framework of acceptability, these two studies developed and assessed the reliability and validity of a new scale to measure the acceptability of mobile health applications (“apps”) among adolescents.

Methods

We followed a structured scale development process including exploratory factor analyses (EFAs), confirmatory factor analyses (CFAs), and employed structural equation modeling (SEM) to assess the relationship between the scale and app usage. Adolescent participants used the Fooducate healthy eating app and completed the acceptability scale at baseline and one-week follow-up.

Results

EFA (n = 182) determined that the acceptability of health apps was a multidimensional construct with six latent factors: affective attitude, burden, ethicality, intervention coherence, perceived effectiveness, and self-efficacy. CFA (n = 161) from the second sample affirmed the six-factor structure and the unidimensional structures for each of the six subscales. However, CFA did not confirm the higher-order latent factor model suggesting that the six subscales reflect unique aspects of acceptability. SEM indicated that two of the subscales—ethicality and self-efficacy—were predictive of health app usage at one-week follow-up.

Conclusions

These results highlight the importance of ethicality and self-efficacy for health app acceptability. Future research testing and adapting this new acceptability scale will enhance measurement tools in the fields of mobile health and adolescent health.

Feasibility and Acceptability of 'VitaVillage': A Serious Game for Nutrition Education

Computer games have previously been used to improve nutrition knowledge in children. This paper describes the acceptability and feasibility of a serious game, "VitaVillage", for improving child nutrition knowledge. VitaVillage is a farming-style game in which the player undertakes quests and completes questions aimed at increasing several aspects of nutrition and healthy eating knowledge. Children aged 9-12 years in two primary schools (control vs. intervention) completed a nutrition knowledge questionnaire at baseline (T1) and after 1 week (T2). Participants at the intervention school (n = 75) played VitaVillage for 20 minutes on two occasions. Control participants (n = 94) received no nutrition education. Likeability question scores and written feedback from intervention participants was reported qualitatively. Paired sample t-tests were used to compare T1 and T2 nutrition knowledge changes between control and intervention participants. Engagement with VitaVillage improved children's overall nutrition knowledge (Mean increase of 2.25 points between T1 and T2, Standard Deviation (SD) 6.31, p = 0.035) compared to controls. The game was liked overall (mean score 77 (SD 24.6) on scale of 0-100) and positive feedback was given. Results indicate that VitaVillage has the potential to be successful as a nutrition education tool. In the future, VitaVillage's content and gameplay will be revised, extended and evaluated for its long-term impact on eating behaviour and knowledge changes.

Pilot evaluation of an interactive multimedia platform to provide nutrition education to Portuguese adolescents

Background

Obesity prevalence has been rising worldwide and currently is one of the most serious public health problems. Nutrition literacy is important to the development of healthier habits that could help prevent and stem obesity and overweight. The aim of this study was to evaluate the impact of using a multimedia web platform to provide nutrition education to Portuguese adolescents.

Methods

The intervention consisted in a two-week period in which students (n = 1291) had access to an interactive multimedia web platform with nutritional content, and designed for a self-paced learning experience. Students completed a knowledge questionnaire at baseline and immediately after the end of the intervention.

Results

The results obtained revealed that 85.8% of the students increased their nutrition knowledge. No gender differences were observed post-intervention. There were significant differences in the knowledge acquisition regarding age (P &lt; 0.001). The baseline knowledge seemed to influence the learning process.

Conclusions

Overall, the intervention had a positive impact. The preliminary results observed will be important for the improvement of the intervention, though they need to be confirmed by further research. Nevertheless, it is safe to say that technology-based assets can be important tools to incorporate and complement health-related interventions in schools.

Características de las intervenciones realizadas con adolescentes en condición de sobrepeso y obesidad: una revisión integrativa

Introducción: Dado que el sobrepeso y la obesidad en la población adolescente van en aumento, es necesario identificar las intervenciones para la prevención y manejo de estas condiciones en el grupo de jóvenes. Objetivo: Presentar la evidencia encontrada, en relación con las características de las intervenciones publicadas en revistas científicas indexadas, sobre la prevención y manejo del sobrepeso y de la obesidad, respecto de la nutrición y la actividad física, para ser utilizada en la toma de decisiones, en cuanto a políticas y programas de promoción y prevención de esta condición de salud. Materiales y Métodos: Se realizó la revisión sistemática de estudios cualitativos y cuantitativos (desde descriptivos hasta experimentales, que incluyeran tanto revisiones sistemáticas como meta-análisis), publicados en el período comprendido entre 2005 y 2017, a través de las bases de datos PubMed y ScienceDirect, las bibliotecas virtuales Ovid y SciELO, y el compendio de revisiones Cochrane. Resultados: Existe gran variedad en diseño e implementación de las intervenciones, en cuanto a componentes, teorías, escenarios, evaluación de los efectos, dosis, tiempo y seguimiento, que tienen efecto en los hábitos nutricionales, en la actividad física, en la autoeficacia y en el índice de masa corporal (IMC) de la población estudiada. Discusión: La efectividad de las intervenciones varía, dependiendo de los componentes y de la fidelidad en la aplicación de la misma, lo cual debe revisarse a la luz de los mejores efectos encontrados. Conclusiones: 47 estudios cumplieron los requisitos de inclusión. Las intervenciones se robustecen con el uso de una teoría que direccione y fundamente los hallazgos que permitan dar mayores y mejores resultados. Los componentes de las intervenciones incluyen: duración, dosis, intensidad de la intervención, respuesta y seguimiento. Los adolescentes prefieren metodologías participativas e interactivas; sin embargo, aún no existe una intervención concreta y claramente definida que pueda ser estandarizada para enfrentar este problema de salud. Como citar este artículo: Bonilla CP, Díaz LP. Características de las intervenciones realizadas con adolescentes en condición de sobrepeso y obesidad: una revisión integrativa. Rev Cuid. 2019; 10(3): e681. http://dx.doi.org/10.15649/cuidarte.v10i3.681

Food literacy programmes in secondary schools: a systematic literature review and narrative synthesis of quantitative and qualitative evidence

OBJECTIVE

The current review aimed to synthesise the literature on food literacy interventions among adolescents in secondary schools, the attitudes and perceptions of food literacy interventions in secondary schools, and their effects on dietary outcomes.

DESIGN

The systematic review searched five electronic databases from the earliest record to present.

SETTING

The studies selected for the review were from sixteen countries: Australia (n 10), Canada (n 1), China (n 1), France (n 1), Greece (n 2), Iran (n 1), South Africa (n 1), South India (n 1), Kenya (n 1), Norway (n 2), Portugal (n 1), Denmark (n 1), Northern Ireland (n 1), USA (n 17), UK (n 1) and Sweden (n 2).

PARTICIPANTS

Adolescents aged 10-19 years.

RESULTS

Forty-four studies were eligible for inclusion. Adolescents with greater nutritional knowledge and food skills showed healthier dietary practices. Studies found a mixed association between food literacy and long-term healthy dietary behaviour. Two studies showed an improvement in adolescents' cooking skills and food safety knowledge; six studies showed an improvement in overall food safety knowledge; six studies showed an improvement in overall food and nutritional knowledge; and two studies showed an improvement in short-term healthy dietary behaviour.

CONCLUSIONS

Food literacy interventions conducted in a secondary-school setting have demonstrated a positive impact on healthy food and nutritional knowledge. However, there appears to be limited evidence supporting food literacy interventions and long-term dietary behaviours in adolescents. More evidence-based research is required to adequately measure all domains of food literacy and more age-specific food literacy interventions.

A Systematic Review of Tools Measuring Nutrition Knowledge of Pre-Adolescents and Adolescents in a School-Based Setting

BACKGROUND

Measurement of nutrition knowledge is common in interventions targeting dietary modifications in a school-based setting. Previous research has noted a general lack of disclosure regarding the details and psychometric properties of nutrition knowledge tools, which makes uptake of previously used instruments extremely difficult.

METHODS

Our systematic literature review sought to identify interventions measuring nutrition knowledge in school settings to students aged 9 to 18. Studies were categorized according to content subject and relevant descriptive characteristics and psychometric properties were extracted.

RESULTS

Following the initial screening of 16,868 articles, 308 papers were evaluated for eligibility. Sixty-seven studies consistent with the inclusion criteria were included in the review. A minority of studies reported analysis of validity (31.3%) and/or reliability (40.3%), and 73.1% of studies had at least one unknown relevant descriptive characteristic. The majority (68.7%) of studies were custom developed, of which only 13 reproduced the tool in the publication.

CONCLUSION

Overall, there was an alarming lack of reporting across studies, both in terms of the description of knowledge tools as well as their psychometric properties. These omissions make the selection of appropriate instruments for use in novel contexts difficult, and highlight the need for greater disclosure and pre-intervention testing.

Digital technologies for promotion of healthy eating habits in teenagers

OBJECTIVE

Identify and analyze the scientific literature on digital technologies for promotion of healthy eating habits in teenagers.

METHOD

Integrative review of articles published in English and Spanish, available in full on four databases. The descriptors used were (Adolescent health) OR (Teen health) AND (Healthy diet) OR (Healthy eating) AND (Educational technology) OR (Instructional technology), respectively, from which eight articles were selected.

RESULTS

Among the studies included, three were digital games; two web-based nutrition interventions; two using online programs to prevent obesity; and one nutritional advice using multimedia. They showed experiences of digital technology and its effects on knowledge improvement and/or behavior of participants when developing healthy eating habits.

CONCLUSION

Digital technologies are innovative tools present in the lives of teenagers, with the possibility of being used for education and promotion of healthy eating, contributing to the empowerment of the subject for his/her self-care.

Effectiveness of technology-based educational interventions on the empowerment related outcomes of children and young adults with cancer: A quantitative systematic review

AIM

To determine the effectiveness of technological-based educational interventions on the empowerment-related outcomes of children and young adults with cancer.

DESIGN

Quantitative systematic review.

DATA SOURCES

Six electronic databases, including PubMed, Cochrane Library, EMBASE, CINAHL, Scopus, and PsycINFO, were searched to identify eligible randomized controlled trials from each database's point of inception to December 2017. Grey literature was also searched from ProQuest and MedNar.

REVIEW METHODS

A narrative summary of the results was undertaken owing to the small number of eligible studies and high heterogeneity across the studies.

RESULTS

Five studies were included in the review. Five empowerment-related outcomes under the domain "patient states" were identified at differing time points of 3-month postintervention, immediate postintervention, and during treatment: (a) self-efficacy; (b) cancer knowledge; (c) health locus of control; (d) emotional well-being; and (e) quality of life. At 3-month postintervention, health locus of control was found to be significant in two studies and self-efficacy and cancer knowledge were found to be significant in one study. No difference in quality of life was found. At immediate postintervention, a beneficial indication was observed. During treatment, no statistical significance was found regarding the effectiveness of a technological-based cognitive behavioural package.

CONCLUSION

Weak evidences led to inconclusive findings on the effectiveness of technological-based educational interventions on the empowerment-related outcomes of children and young adults with cancer. Future research will benefit from well-designed clinical trials that use a common outcome measurement to provide more information regarding the effectiveness of such interventions.

The Relationship Between Self-Efficacy and Well-Being Among Surgical Residents

OBJECTIVE

Residency is a challenging time in the lives of physicians. In this study, we examined the relationship between general self-efficacy, defined as the belief in one's own capabilities in a variety of situations, and burnout and psychological well-being in a sample of surgical residents.

DESIGN

In the context of a larger study, a cross-sectional survey was administered to residents. The survey included measures of general self-efficacy, the emotional exhaustion and personal accomplishment domains of burnout, and general psychological well-being. We examined correlations between self-efficacy and these well-being outcomes and used multivariable linear regression models that controlled for age, gender, postgraduate year, ethnicity, and the interaction between gender and self-efficacy.

SETTING

We surveyed residents at Stanford Health Care, a tertiary care center, between the fall of 2010 and the spring of 2013.

PARTICIPANTS

One hundred and seventy nine residents from 9 surgical subspecialties responded to the survey for a response rate of 76%.

RESULTS

Residents reported high levels of self-efficacy, and over a third reported high emotional exhaustion. Eighty-nine percent of residents had average or high personal accomplishment. In adjusted regression analyses, general self-efficacy was negatively predictive of emotional exhaustion (B = -0.43, p = 0.0127) and positively predictive of personal accomplishment (B = 0.33, p = 0.0185) and general psychological well-being (B = 0.34, p = 0.0010). There was no interaction between gender and general self-efficacy in regression analyses (ps ≥ 0.6776).

CONCLUSIONS

Among other factors, self-efficacy appears to be significantly predictive of resident well-being. High self-efficacy suggests that residents feel prepared and capable. Interventions to improve residents' general self-efficacy should be explored as a possible mechanism to improve well-being.

Digital Gaming for Nutritional Education: A Survey on Preferences, Motives, and Needs of Children and Adolescents

Background

Use of novel information and communication technologies are frequently discussed as promising tools to prevent and treat overweight and obesity in children and adolescents.

Objective

This survey aims to describe the preferences, motives, and needs of children and adolescents regarding nutrition and digital games.

Methods

We conducted a survey in 6 secondary schools in the southern region of Germany using a 43-item questionnaire. Questions referred to preferences, motives, and needs of children and adolescents regarding nutrition and digital games. In addition, knowledge regarding nutrition was assessed with 4 questions. We collected self-reported sociodemographic and anthropometric data. Descriptive statistical analyses were performed using SPSS.

Results

In total, 293 children and adolescents participated in the study, with ages 12-18 years (137 girls, 46.8%), weight 30.0-120.0 (mean 60.2 [SD 13.2]) kg, and height 1.4-2.0 (mean 1.7 [SD 0.1]) m. A total of 5.5% (16/290) correctly answered the 4 questions regarding nutrition knowledge. Study participants acquired digital nutritional information primarily from the internet (166/291, 57.0%) and television (97/291, 33.3%), while school education (161/291, 55.3%) and parents or other adults (209/291, 71.8%) were the most relevant nondigital information sources. Most participants (242/283, 85.5%) reported that they regularly play digital games. More than half (144/236, 61.0%) stated that they play digital games on a daily basis on their smartphones or tablets, and almost 70% (151/282, 66.5%) reported playing digital games for ≤30 minutes without any interruption. One-half of respondents (144/280, 51.4%) also stated that they were interested in receiving information about nutrition while playing digital games.

Conclusions

This survey suggests that nutrition knowledge in children and adolescents might be deficient. Most children and adolescents play digital games and express interest in acquiring nutritional information during digital gameplay. A digital game with a focus on sound nutrition could be a potential educational tool for imparting nutrition knowledge and promoting healthier nutrition behaviors in children and adolescents.

A School-Based Program to Promote Well-Being in Preadolescents: Results From a Cluster Quasi-Experimental Controlled Study

Diario della Salute [My Health Diary] is a school-based program designed to enhance the subjective well-being and health of 12- to 13-year-old students. We hypothesized that providing students with the social and emotional skills to fulfill their potential and deal with common developmental tasks of adolescence (e.g., onset of puberty, identity development, increased responsibilities and academic demands) would result in improved well-being and health. The program comprises five standardized interactive lessons concerning common psychosocial and health issues in adolescence, and two narrative booklets addressed to both students and their parents. We evaluated the effectiveness of the program in terms of the students’ subjective well-being, aggressive behavior, and health behavior. Using a quasi-experimental study design, schools in the intervention group implemented the full program and those in the comparison group received their regular curriculum. We administered measures of the study’s objectives both before and after program implementation. Statistical analyses accounted for within-school clustering, potential socioeconomic and demographic confounding, and pre-implementation levels of these measures. We sampled 62 schools and allocated 2630 students to either an intervention or comparison group. Sociodemographic characteristics and baseline outcomes were balanced across study groups. Unexpectedly, respondents in the intervention group had 0.38 greater mean adjusted score of the WHO/Europe Health Behaviour in School-Aged Children Symptom Checklist instrument than respondents in the comparison group, indicating a reduction in subjective well-being. We did not observe any program effects on aggressive and health behaviors. The apparent reduction in subjective well-being reflected by an increased perception of psychosomatic complaints is suggestive of either increased emotional competence or, potentially, iatrogenic program effects. While greater emotional competence is positively associated with well-being over the course of life, the program in its present form should not be disseminated due to the possibility of adverse unintended effects.

Effectiveness and Behavioral Mechanisms of Social Media Interventions for Positive Nutrition Behaviors in Adolescents: A Systematic Review

PURPOSE

To determine the effectiveness of social media-based interventions in promoting positive changes in nutrition behaviors amongst adolescents, and identify the behavior change technique(s) (BCT(s)) that were used in effective interventions.

METHODS

MEDLINE, Embase, PsycINFO, Cinahl, and Cochrane library were systematically searched. Eligible studies included: participants aged 13-18 years; use of one or more social media platform(s) in the intervention; a comparison group not exposed to the social media-based intervention; nutrition- and diet-related behavior outcome(s); and an experimental study design. BCTs were identified using a behavior change taxonomy. Quality and risk of bias assessments were also conducted.

RESULTS

Seven eligible interventions were included, varying from internet-only programs to in-person programs with internet or website-based component(s). Studies used relatively outdated forms of social media such as purpose-built discussion boards or chat rooms rather than commercial social media interfaces (e.g. Facebook). Five of the seven interventions demonstrated improvements in at least one nutrition behavior. The most common improvement was for fruit or vegetable intake, and two of four studies showed improvements for sugar-sweetened beverage consumption. The most common BCT used was social support, followed by demonstration of behavior, self-monitoring, goal setting, and feedback.

CONCLUSIONS

The current evidence base is equivocal with respect to changing overall dietary behaviors, as increasing intakes of desirable food groups were more successful than decreasing unfavorable food habits. Further research using better quality interventions, full description of the BCTs, long-term follow-up, and popular contemporary social media platforms to build the evidence base are required.

Prevalence of health-risk behaviors among teen girls in Southeastern Iran

Background

Investigating female adolescents’ health status is essential because of their two-fold role within the health of the community and the impending generations’ health.

Objective

The present study aimed to determine the prevalence of health-risk behaviors among teen girls in Southeastern Iran.

Methods

This cross-sectional study was carried out on a sample of 457 tenth grade female adolescents in four public high schools in Zahedan in Southeastern Iran, in 2015. First, high schools were randomly selected; then, all students in Grade 10 were enrolled in the study through a census. Data were collected using a self-reported questionnaire of the health-risk behaviors with the content validity ratio (CVR) of 0.80, the content validity index (CVI) of 0.88 and Cronbach’s α score of 0.71. The Results were analyzed using ANOVA test with SPSS-15.

Results

The highest prevalence rate of health-risk behaviors of students included: failing to drink natural fruit juice (53.1%), failing to wear a seat belt (43.0%), sitting in a car while the driver is sending message or emails (43.0%), failing to drink milk daily (36.0%), lack of minimum daily physical activity 37.0%, and watching TV more than 3 hours a day (35.0%). On average, the number of health-risk behaviors among under study students was 1.47. Additionally, the ANOVA showed a statistically significant difference in the average number of health-risk behaviors of adolescents in families with high economic status, those who never talked with their parents or those who had physical relations with the opposite sex (p<0.001).

Conclusion

It is suggested that attention be paid to emphasizing the pattern of healthy eating, increasing physical activity, and reducing unsafe behaviors in adolescents; moreover, behavioral consultation should be given regarding relationships with the opposite sex. Furthermore, more attention must be paid to the familiar behavior patterns and the relationships in school health programs.

Food Safety Knowledge and Practices of Male Adolescents in West of Iran

BACKGROUND:

Every year many people around the world become infected with food-borne infections. Insufficient knowledge and skills related to food safety and hygiene are among the factors affecting the incidence of food-borne diseases, especially in adolescents.

AIM:

The purpose of this study was to determine the knowledge and practices associated with food safety and hygiene in Ilam city male adolescents.

MATERIAL AND METHODS:

Three hundred and eighty of male adolescents aged 13 to 19 were selected randomly and entered the cross-sectional study. Data were collected using a researcher-made questionnaire From December 2016 to February 2017. Descriptive statistics, Pearson correlation, independent t-test and one-way ANOVA were used to analyse the data in SPSS software (version 19.0).

RESULTS:

The findings of the study showed a positive and significant relationship between knowledge and practices related to food safety and hygiene (r = 0.122; p = 0.018). Also, the findings showed that food safety knowledge and practice of adolescents were significantly affected by the level of their education, parental education level, parental employment status and household economic conditions, (p < 0.005). Also, the results showed that the participants generally obtained 57.74% of the knowledge score and 57.63% of practices score. The subjects had the most knowledge about food supply and storage (60%), and the highest practice was related to personal and environmental hygiene, (61.73%).

CONCLUSION:

The inadequacy of knowledge and performance of adolescents about food safety and hygiene shows the need for implementation of health education interventions in this area.

What's technology cooking up? A systematic review of the use of technology in adolescent food literacy programs

Over one-third of adolescents are overweight or obese. Food literacy (FL), the ability to plan and manage, select, prepare, and eat healthy foods, is a contemporary concept that provides a mechanism to understand the relationship between food-related knowledge and skills and dietary intake. Innovative interventions which focus on the core concepts of FL and include generationally appropriate technology have the potential to provide positive impact on the dietary habits of adolescents. This systematic review followed PRISMA guidelines and employed the Downs and Black criteria for rating studies. Titles and abstracts of 545 articles were collected and reviewed from 13 electronic databases. Studies were selected if they were peer-reviewed, included adolescents 12-19 years-old, incorporated concepts related to FL, and employed technology as part of the intervention. Eight studies, six randomized controlled trials (RCT) and two interventions without controls were included. Seven of the interventions used Internet or web-based platforms to access program components and all RCTs incorporated game elements. Studies included between two and four constructs of FL. All reported positive changes in food intake with five reporting significant positive pre- and post-intervention changes. Few technology-driven FL-related studies exist within the literature. Although all studies reported improvements in dietary intake, due to variation in program design, delivery, and evaluation it is difficult to tease out the effect of the technology component. Continued research is needed to: 1) determine the degree to which FL should be included in interventions to effect a positive change on dietary intake; 2) develop adolescent-specific FL measures to more appropriately evaluate changes in knowledge, food-related skills, and dietary intake; and 3) design technology-driven interventions so that technology components can be analyzed separately from other program elements.

"Just Say It Like It Is!" Use of a Community-Based Participatory Approach to Develop a Technology-Driven Food Literacy Program for Adolescents

FuelUp&Go! is a technology-driven food literacy program consisting of six in-person skill building sessions as well as fitness trackers, text messages, and a companion website. A community-based participatory research approach was used with adolescents who were recruited to participate in a Kid Council. Qualitative data were collected about the use of surveys, program activities, recipes, technology and text messages, and music and incentives. Changes suggested by Kid Councilmembers informed the design and development of a pilot program. Participants were recruited for the pilot program and completed pre- and postintervention surveys. The results indicated food-related knowledge remained low but increased from baseline to follow-up. Attitudes toward vegetables and physical activity increased slightly. Self-reported participation in physical activity and consumption of sugar-added beverages moved in positive directions. These findings suggest that community-based participatory research approach is an effective approach to engage adolescents in the development of a technology-driven food literacy program.

Internet Based Obesity Prevention Program for Thai School Children- A Randomized Control Trial

INTRODUCTION

Internet based obesity prevention program is one approach in learning strategies to improve healthy behaviour. It has been advocated as one strategy to address the rising prevalence of childhood obesity; however, their efficacy is not seen consistently.

AIM

The purpose of this study was to assess the efficacy of internet based obesity prevention program in Thai school children.

MATERIALS AND METHODS

Healthy children studying in public schools in one township of central Thailand were randomly assigned to either the intervention (internet based) program or the control group. Anthropometric characteristics were recorded at baseline and for the next four following months at monthly intervals. Changes in the percentage of overweight/obese children and changes in BMI at the end of study were considered as the primary and secondary outcome, respectively.

RESULTS

A total of 217 children, mean age of 10.7 years, were included into the final analysis. Baseline anthropometric parameters and percentages of overweight/obesity were not significantly different between groups. At the end of the study, the control group had a higher percentage of overweight/obesity than the intervention group (56.6% vs. 39.6%, respectively; p-value=0.009). Children in the control group had a significantly higher increase in net BMI gains than those in the intervention group (1.24kg/m² vs. 0.40kg/m², p-value=0.027). The intervention group had no changes in BMI z-score (-0.001, 95%CI -0.19 to 0.18, p-value=0.988), contrary to those in the control group, which had significant gain of BMI z-score at the end of study (0.45, 95%CI 0.27 to 0.63, p-value<0.001).

CONCLUSION

Internet the based obesity prevention program was effective in modifying anthropometric outcome and helped to address the rising prevalence of overweight and obese status in Thai children.

Systematic Review of School-Based Interventions to Modify Dietary Behavior: Does Intervention Intensity Impact Effectiveness?

BACKGROUND

Owing to the associations between diet and health, it is important that effective health promotion strategies establish healthful eating behaviors from an early age. We reviewed the intensity of school-based interventions aimed to modify dietary behavior in preadolescent and adolescents and related intervention characteristics to effectiveness.

METHODS

Our systematic literature search of 8 databases sought to identify interventions measuring dietary intake in school settings to students aged 9 to 18. We evaluated these studies for effectiveness, intensity, intervention category, and follow-up measures.

RESULTS

Of the 105 interventions 81 were found to be effective immediately postintervention, irrespective of intensity. Studies that were 6 weeks to 5 months in duration, targeted students' environment or group (alone or in combination), and reached students only in schools were more effective. Only one-fifth of interventions conducted a follow-up measure, and a majority showed a loss of effectiveness from postintervention to follow-up.

CONCLUSIONS

We identified characteristics of effective interventions. These findings may inform the development of future interventions targeting dietary behavior in preadolescents and adolescents in the school-based setting.

The "5 a day" game: a nutritional intervention utilising innovative methodologies with primary school children

The aim of this study was observing and improving children's eating habits through an edutainment technological platform. A single-group education intervention was carried out in primary schools in Parma and Milano, Italy. A total of 76 children (32 females and 44 males, 8-10 years old) were involved in a 3-month nutritional program including lessons and educational videogames. Intakes of fruits, vegetables, juices and dietary total antioxidant capacity (TAC) were measured using 3-day food diaries before and after the intervention. The daily total consumption of fruit and vegetables increased from 421.8 (320.3) to 484.3 (337.2) g/day (p = 0.016). Consequently, daily dietary TAC increased by 26%, rising from 1.4 (1.3) to 1.6 (1.3) mmol of Trolox equivalents (p = 0.006). The methods and, particularly, the use of technological tools proved to be effective in conducting an educational intervention in children aged 8-10 years old.

Automatic detection of confusion in elderly users of a web-based health instruction video

BACKGROUND

Because of cognitive limitations and lower health literacy, many elderly patients have difficulty understanding verbal medical instructions. Automatic detection of facial movements provides a nonintrusive basis for building technological tools supporting confusion detection in healthcare delivery applications on the Internet.

MATERIALS AND METHODS

Twenty-four elderly participants (70-90 years old) were recorded while watching Web-based health instruction videos involving easy and complex medical terminology. Relevant fragments of the participants' facial expressions were rated by 40 medical students for perceived level of confusion and analyzed with automatic software for facial movement recognition.

RESULTS

A computer classification of the automatically detected facial features performed more accurately and with a higher sensitivity than the human observers (automatic detection and classification, 64% accuracy, 0.64 sensitivity; human observers, 41% accuracy, 0.43 sensitivity). A drill-down analysis of cues to confusion indicated the importance of the eye and eyebrow region.

CONCLUSIONS

Confusion caused by misunderstanding of medical terminology is signaled by facial cues that can be automatically detected with currently available facial expression detection technology. The findings are relevant for the development of Web-based services for healthcare consumers.

Dietary self-monitoring, but not dietary quality, improves with use of smartphone app technology in an 8-week weight loss trial

OBJECTIVE

Dietary self-monitoring is linked to improved weight loss success. Mobile technologies, such as smartphone applications (apps), might allow for improved dietary tracking adherence. The authors assessed the use of a popular smartphone app for dietary self-monitoring and weight loss by comparing it with traditional diet counseling and entry methods.

METHODS

Diet tracking and weight loss were compared across participants during an 8-week weight loss trial. Participants tracked intake using 1 of 3 methods: the mobile app "Lose It!", the memo feature on a smartphone, or a traditional paper-and-pencil method.

RESULTS

App users (n = 19) recorded dietary data more consistently compared with the paper-and-pencil group (n = 15; P = .042) but not the memo group (n = 13). All groups lost weight over the course of the study (P = .001), and no difference in weight loss was noted between groups.

CONCLUSIONS AND IMPLICATIONS

Smartphone apps could represent a novel and feasible dietary self-monitoring method for individuals.

"Teens Talk Healthy Weight": the impact of a motivational digital video disc on parental knowledge of obesity-related diseases in an adolescent clinic

The purpose of the study was to investigate the impact of a 7-minute educational and motivational weight-management digital video disc (DVD) that uses real patient/parent testimonials and provider-patient interactions, on adolescent and parent knowledge of obesity-related diseases; readiness, motivation, and self-efficacy to lose weight; connectedness to care provider; and likelihood of return to clinic for follow-up care. A randomized controlled trial was conducted among 40 overweight/obese adolescent participants (22.5% male, 77.5% female, mean age=15.43 years) and their parents (n=38) who visited a referral-only adolescent clinic for the first time from October 2009 to March 2010. Adolescents were randomly assigned by a research assistant to standard care alone or standard care plus DVD. Standard care (protocol-driven medical and nutritional assessment and counseling) was provided to all adolescents by a registered dietitian nutritionist and physician or nurse practitioner. Adolescents in the intervention group also viewed the DVD. Adolescents and parents completed assessments pre- and post-clinic visit. Repeated measures analysis of covariance was used to evaluate group differences, while controlling for race/ethnicity and age. Parents who viewed the DVD experienced greater improvements in obesity-related disease knowledge than parents who did not view the DVD. Adolescents in both groups improved on measures of motivation to lose weight and dieting self-efficacy, based on pre and post-test questionnaires. A 7-minute educational and motivational DVD helped improve parent knowledge, but was not more powerful than standard care alone in changing other weight-related outcomes in this adolescent clinic. Because it led to increased parental knowledge, incorporating the DVD into clinical practice could also allow more time for health providers to focus on specific obesity-related treatment/education. Future research might examine whether the DVD has more utility in different settings, such as primary care.

iPhone app adherence to expert-recommended guidelines for pediatric obesity prevention

BACKGROUND

Pediatric obesity is a serious and prevalent problem. Smartphone technology, which is becoming increasingly available to children of diverse backgrounds, presents a unique opportunity to instill healthy behaviors before the onset of obesity. Past studies have examined the use of smartphone applications as tools of health behavior modification for adults. The present study examines the content of children's exercise and nutrition smartphone apps.

METHOD

Sixty-two iPhone apps were identified and coded by two independent raters for adherence to expert-recommended behaviors (e.g., five fruits/vegetables per day) and strategies (e.g., self-monitoring diet/physical activity) for the prevention of pediatric obesity.

RESULTS

App behavioral and strategy index scores were uniformly low. Apps were more likely to address expert-recommended behaviors for the prevention of pediatric obesity (93.5%), whereas few apps addressed recommended strategies (20.9%). The most common behaviors addressed included physical activity (53.2%) and fruit/vegetable consumption (48.3%). Other important behaviors (e.g., screen time [1.6%] and family meals together [1.6%]) were rarely addressed.

CONCLUSIONS

Current children's diet and exercise apps could be improved with increased adherence to expert-recommended guidelines, especially expert-recommended strategies.

Development and functionality of a handheld computer program to improve fruit and vegetable intake among low-income youth

Mobile technologies hold promise for improving diet and physical activity, but little attention is given to creating programs that adolescents like and will use. This study developed a personal digital assistant (PDA) program to promote increased intake of fruits and vegetables (FV) in predominately low-income, ethnic minority girls. This study used a three-phase community-engaged process, including (i) engagement of a Student Advisory Board (SAB) to determine comfort with PDAs; (ii) early testing of Prototype I and rapid re-design by the SAB and (iii) feasibility testing of Prototype II in a new sample of girls. Phase 1 results showed that girls were comfortable with the PDA. Testing of Prototype I in Phase 2 showed that acceptability was mixed, with girls responding to 47.3% of the prompts. Girls wanted more reminders, accountability in monitoring FV, help in meeting daily goals and free music downloads based on program use. The PDA was reprogrammed and testing of Prototype II in Phase 3 demonstrated marked improvement in use (78.3%), increases in FV intake (1.8 ± 2.6 daily servings) and good overall satisfaction. Findings suggest that mobile technology designed with the early input of youth is a promising way to improve adolescent health behaviors.

Effectiveness of cell phones and mypyramidtracker.gov to estimate fruit and vegetable intake

AIM AND BACKGROUND

Inadequate fruit and vegetable intake is linked to leading causes of global mortality and rise in obesity. Measuring fruit and vegetable intake is problematic. Advances in cell phone technologies may improve the accuracy and ease of recording diet. This study tested the effectiveness of using cell phones with digital pictures to prompt memory and mypyramidtracker.gov to estimate self-reported fruit and vegetable intake in 69 college students.

METHODS

A repeated measures design was used. Focus groups provided feedback on the acceptability, usability, and feasibility of cell phones for diet recording in this population.

RESULTS

A statistically significant difference in fruit and vegetable scores, F(1, 58)=4.64, p=.04, was supported between cell phone use for short-term memory prompt and mypyramidtracker.gov alone.

CONCLUSIONS

Cell phone pictures improved memory and accuracy of recall when using an online self-reported interactive diet record and was considered an easy, relevant, and accessible way to record diet.

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.

Computer- and web-based interventions to promote healthy eating among children and adolescents: a systematic review

AIMS

To: (1) determine the effect of computer- and web-based interventions on improving eating behavior (e.g. increasing fruit and vegetable consumption; decreasing fat consumption) and/or diet-related physical outcomes (e.g. body mass index) among children and adolescents; and (2) examine what elements enhance success.

BACKGROUND

Children and adolescents are the heaviest they have ever been. Excess weight can carry into adulthood and result in chronic health problems. Because of the capacity to reach large audiences of children and adolescents to promote healthy eating, computer- and web-based interventions hold promise for helping to curb this serious trend. However, evidence to support this approach is lacking.

DESIGN

Systematic review using guidelines from the Cochrane Effective Practice and Organisation of Care Group.

DATA SOURCES

The following databases were searched for studies from 1998-2011: CINAHL; PubMed; Cochrane; PsycINFO; ERIC; and Proquest.

REVIEW METHODS

Fifteen randomized controlled trials or quasi-experimental studies were analysed in a systematic review.

RESULTS

Although a majority of interventions resulted in statistically significant positive changes in eating behavior and/or diet-related physical outcomes, interventions that included post intervention follow-up, ranging from 3-18 months, showed that changes were not maintained. Elements, such as conducting the intervention at school or using individually tailored feedback, may enhance success.

CONCLUSION

Computer- and web-based interventions can improve eating behavior and diet-related physical outcomes among children and adolescents, particularly when conducted in schools and individually tailored. These interventions can complement and support nursing efforts to give preventive care; however, maintenance efforts are recommended.

The use of web-based interventions to prevent excessive weight gain

We reviewed web-based interventions for overweight and obesity prevention. A literature search was conducted using seven electronic databases. Manually searched articles were also included. Thirty studies fulfilled the inclusion criteria. Of these, 13 studied physical activity, eight studied dietary practices and nine studied a combination of physical activity and dietary practice. Twenty-eight of the studies (93%) reported positive changes in moderate to vigorous physical activity level, fruit and vegetable intake and psychological factors. A meta-analysis showed there were improvements, though not significant, in fruit and vegetable consumption (standardised mean difference, SMD = 0.61; 95% CI =-0.13 to 1.35) and physical activity (SMD = 0.15; 95% CI =-0.06 to 0.35). The review suggests that web-based interventions are a useful educational tool for increasing awareness and making healthy behaviour changes in relation to an excessive weight gain problem.

Reliability and validity of a fruit and vegetable self-efficacy instrument for secondary-school students in the Netherlands

Objective

To develop a ‘fruit self-efficacy’ (FSE) instrument and a ‘vegetable self-efficacy’ (VSE) instrument for secondary-school students in the Netherlands and to test the reliability and validity of these instruments.

Design

Methodological research.

Setting

Seven secondary schools in the Netherlands.

Subjects

Students (11–19 years of age) completed the two instruments in the classroom (n 466). Out of the original subject group, 106 students completed the instruments a second time.

Results

The relevance of the twenty-two items of the two developed instruments was evaluated on two occasions by four experts. This procedure resulted in seventeen items for both instruments. Further analysis was carried out on the basis of the secondary-school students’ answers. Factor analysis identified two unidimensional instruments. Cronbach's α was 0·94 for the FSE instrument and 0·95 for the VSE instrument. The intra-class correlation coefficient between the test and the retest for both instruments varied between 0·33 and 0·84 (P < 0·05), depending on how the tests were taken (during class or on the student's own initiative), and the order in which the tests were completed (started or finished with a different instrument used for similar research). The correlation between FSE and fruit consumption was 0·41 (P < 0·01) and between VSE and vegetable consumption was 0·32 (P < 0·01).

Conclusions

The two instruments are sufficiently reliable and valid to assess the FSE and VSE of secondary-school students in the Netherlands. Further research, in which the predominant ethnic minorities in the Netherlands are sufficiently represented, is required to confirm this conclusion.

A review of electronic interventions for prevention and treatment of overweight and obesity in young people

The objective of this systematic review is to provide a qualitative comparison of interactive electronic media interventions for the prevention or treatment of obesity and/or obesity-related behaviours in children and adolescents. Literature searches of 12 databases from the earliest publication date until March 2010 were conducted. Twenty-four studies in which children and/or adolescents interacted with electronic interventions delivered as adjunct or sole interventions for the prevention or treatment of obesity and/or obesity-related behaviours met the inclusion criteria. Fifteen focussed on obesity prevention and nine on treatment interventions. The average study quality design score was 45%. Most studies demonstrated some form of significant outcome (e.g. reported changes in dietary and/or physical activity behaviours) in participants receiving interactive electronic interventions, with 11 out of 15 studies leading to positive changes in measured or reported adiposity outcomes. In 87% of studies, the effects of interactive electronic interventions were not separately evaluated from other intervention components. These results should be viewed with caution because of the overall poor quality of the studies. Studies were mostly conducted in the USA, largely in minority populations, and the direct transferability of interventions to other populations is unclear. Further high quality research is needed in this area to accurately inform the evidence base.

Rural adults' use of health-related information online: data from a 2006 National Online Health Survey

OBJECTIVE

The objective of this study was to examine access and use of health-related information online in rural versus nonrural Internet users, using national data from the 2006 Pew Internet and American Life Project.

MATERIALS AND METHODS

A national telephone survey of 2,928 adults in August 2006 yielded a sample of 1,992 adults who use the Internet regularly. A structured interview was administered to assess frequency of Internet use and access and use of health-related information online.

RESULTS

Most Internet-using rural adults search for health-related information online; two-thirds seek information about specific medical problems and over half seek information about treatment. Three-fifths of rural adults surveyed stated that online health-related information affected the decisions they made in health maintenance and managing treatment of an illness. More than one-third reported being significantly helped by information they found, whereas one-fourth reported being confused. Comparisons between rural and nonrural Internet users suggested that rural users were more likely to seek information about smoking cessation (χ(2)[1, N=1,990]=7.91, p<0.01) and mental health issues (χ(2)[1, N=1,988]=3.71, p=0.05), less likely to seek information about a particular doctor or hospital (χ(2)[1, N=1,983]=15.49, p<0.001), and more likely to report being helped (χ(2)[1, N=1,534]=5.24, p<0.05)-but also confused (χ(2)[1, N=1,592]=9.83, p<0.01)-by information they found.

CONCLUSIONS

Rural Americans are increasingly using the Internet to acquire information about chronic disease, mental health, doctors, and treatment options. Priorities should include further development and rigorous evaluation of online resources to ensure high-quality, more direct tailoring of resources to rural families and development of tools to assist consumers in assessing the credibility of online information.

Evidence review of technology and dietary assessment

SIGNIFICANCE

Diets high in fruit and vegetable consumption are associated with a decrease in chronic diseases. Dietary factors are linked to 4 of the 10 leading noncommunicable causes of death: cardiovascular disease, some cancers, stroke, and type 2 diabetes. Accurately measuring dietary patterns has many challenges. Dietary intake measurement has traditionally relied on self-report instruments such as 24-hour recall, food record, and food frequency questionnaires to record consumption history. These methods have inherent limitations in detecting small but important changes in fruit and vegetable consumption patterns. Promising advances in technology have made more sophisticated techniques for recording dietary intake possible. Computers and Web-based programs, handheld personal digital assistants with cameras and telephone cards, smart phones, cameras, and video recorders options may reduce the burden of recording what has been consumed. Furthermore, technology-based methods of dietary assessment may provide a higher degree of reliability and validity in visually determining fruit and vegetable consumption, and additional study is warranted.

PURPOSE

The purpose of this article is to present a review of the evidence on the effectiveness of technology-based methods for dietary assessment, which included fruit and vegetable consumption.

APPROACH

One hundred and eighty-seven articles published between 1998 and 2008 were initially identified. Fifteen met the study inclusion criteria and were evaluated by an interdisciplinary team using the Stetler Strength of Evidence Scale.

RESULTS

Six technology-based methods for dietary assessment were identified. Findings from validity and reliability testing of technology-based methods are encouraging and need replication. Clinically important features offered through technology may reduce reporting burden and offer behavioral feedback to users. Methodologically sound, empirical research into using technology-based application for dietary assessment in a variety of populations of sufficient size is needed.

Electronic therapeutic contact for adolescent weight management: the Loozit study

OBJECTIVE

To examine adolescent and facilitator participation in the first 10 months of an obesity management intervention including electronic contact (e-contact) via e-mail and short message service (SMS) communication.

MATERIALS AND METHODS

Participants (n=49) were overweight and obese (13-16 year olds) and were randomized to receive e-contact in the Loozit trial. Adolescents were sent brief, semipersonalized health messages approximately monthly, from 2 to 12 months. We analyzed adolescents' response patterns, reply content, satisfaction with e-contact intervention, and facilitator responsiveness. Two coding systems described the general attributes and content of adolescent replies and facilitator responses.

RESULTS

Adolescents' overall reply rate was 22%. There was no difference in age, sex, socioeconomic status, body mass index z-score, or initial group program attendance between the 27 adolescents who replied to 0-2 messages and the 22 who replied to >or=3 messages. Adolescent SMS replies had less characters and a quicker response time compared with e-mail replies. Adolescent responses were largely relevant to initial health messages sent (91%), with few using "SMS language" (17%) or emoticons (7%). Most adolescents rated e-contact as "somewhat helpful." Facilitators responded to 93% of adolescent replies, and most responses were personalized (93%), encouraging (88%), and educational (75%).

CONCLUSIONS

Although adolescent engagement was modest, SMS and e-mail communication is a feasible and acceptable adjunct to group lifestyle intervention and telephone coaching in overweight and obese adolescents. Healthy eating messages and those concluding with "please reply" elicited the highest reply rates, and thus these message types should be included in future adolescent e-contact interventions.

A content analysis of kindergarten-12th grade school-based nutrition interventions: taking advantage of past learning

OBJECTIVE

To review the literature, identifying proposed recommendations for school-based nutrition interventions, and evaluate kindergarten through 12th grade school-based nutrition interventions conducted from 2000-2008.

DESIGN

Proposed recommendations from school-based intervention reviews were developed and used in conducting a content analysis of 26 interventions.

PARTICIPANTS

Twenty-six school-based nutrition interventions in the United States first published in peer-reviewed journals from 2000-2008. VARIABLE MEASURED: Ten proposed recommendations based on prior analyses of school-based nutrition interventions: (1) behaviorally focused, (2) multicomponents, (3) healthful food/school environment, (4) family involvement, (5) self-assessments, (6) quantitative evaluation, (7) community involvement, (8) ethnic/heterogeneous groups, (9) multimedia technology, and (10) sequential and sufficient duration.

ANALYSIS

Descriptive statistics.

RESULTS

The most frequent recommendations used were: (1) behaviorally focused components (100%) and (2) quantitative evaluation of food behaviors (96%). Only 15% of the interventions included community involvement or ethnic/heterogeneous groups, whereas 31% included anthropometric measures. Five of the 10 proposed recommendations were included in over 50% of the interventions.

CONCLUSIONS AND IMPLICATIONS

Rising trend of overweight children warrants the need to synthesize findings from previous studies to inform research and program development and assist in identification of high-impact strategies and tactics.

A meta-analytic review of eHealth interventions for pediatric health promoting and maintaining behaviors

OBJECTIVE

The current study quantitatively evaluated the impact of eHealth interventions on pediatric health promoting and maintaining behaviors believed to impact the development or worsening of a physical disease and their associated outcomes.

METHOD

PsycINFO, PUBMED/MEDLINE, Educational Resources Information Center (ERIC), and reference sections of identified articles were searched.

RESULTS

An omnibus weighted mean effect size for all identified eHealth interventions revealed a small, but significant, effect (mean d = .118, 95% confidence interval [CI] = .066-.171). However, when considered independently, educational interventions demonstrated no significant effect on pediatric health behavior or health outcomes. Behavioral eHealth interventions produced relatively homogeneous effects that were small but significantly different from zero (mean d = .354, 95% CI = .232-.475).

CONCLUSION

eHealth interventions that incorporate behavioral methods (e.g., self-monitoring, goal setting, immediate feedback, contingency management) produce larger effect sizes for health behaviors and their associated outcomes than interventions that rely solely on education.

Validity and reliability of a nutrition knowledge survey for assessment in elementary school children

Limited surveys are available to assess the nutrition knowledge of children. The goals of this study were to test the validity and reliability of a computer nutrition knowledge survey for elementary school students and to evaluate the impact of the "Fit Kids 'r' Healthy Kids" nutrition intervention via the knowledge survey. During survey development, a sample (n=12) of health educators, elementary school teachers, and registered dietitians assessed the survey. The target population consisted of first- through fourth-grade students from Salt Lake City, UT, metropolitan area schools. Participants were divided into reliability (n=68), intervention (n=74), and control groups (n=59). The reliability group took the survey twice (2 weeks apart); the intervention and control groups also took the survey twice, but at pre- and post-intervention (4 weeks later). Only students from the intervention group participated in four weekly nutrition classes. Reliability was assessed by Pearson's correlation coefficients for knowledge scores. Results demonstrated appropriate content validity, as indicated by expert peer ratings. Test-retest reliability correlations were found to be significant for the overall survey (r=0.54; P<0.001) and for all subscales: food groups, healthful foods, and food functions (r=0.51, 0.65, and 0.49, respectively; P<0.001). Nutrition knowledge was assessed upon program completion with paired samples t tests. Students from the intervention group demonstrated improvement in nutrition knowledge (12.2+/-1.9 to 13.5+/-1.6; P<0.001), while scores for the control group remained unchanged. The difference in total scores from pre- to post-intervention between the two groups was significant (P<0.001). These results suggest that the computerized nutrition survey demonstrated content validity and test-retest reliability for first- through fourth-grade elementary school children. Also, the study results imply that the Fit Kids 'r' Healthy Kids intervention promoted gains in nutrition knowledge. Overall, the computer survey shows promise as an appealing medium for assessing nutrition knowledge in children.

Moderators of physical activity and obesity during adolescence

The purpose of this study was to examine possible moderators of the relation between physical activity and obesity in adolescence. Adolescents (N=168; mean age=15.20 years; 52.4% girls; 76.8% African American) were recruited from low-income primary care medical facilities in a large southern city. Measures included Body Mass Index (BMI) percentile, physical activity, shared family physical activity, and self-efficacy for healthful eating. Multiple regression analyses were conducted to investigate a) independent contributions of physical activity, shared family activity, and self-efficacy for healthful eating to the prediction of adolescent BMI percentile; b) interactions between shared and individual physical activity in the prediction of BMI percentile; c) interactions between self-efficacy for healthful eating and physical activity in the prediction of BMI percentile; and d) interactions among all three variables. Findings revealed self-efficacy for healthful eating was a significant moderator of the adolescent physical activity and BMI percentile relation. Conclusions emphasize the interactive nature among obesity risk factors.

To what extent have high schools in California been able to implement state-mandated nutrition standards?

PURPOSE

To determine extent and factors associated with implementation of California's school nutrition standards 1 year after standards became active.

METHODS

Information on competitive foods and beverages available in schools was collected from a representative sample of 56 public high schools in California. Adherence to nutrition standards was calculated for each item and summarized for each school by venue. The association between schools' sociodemographic characteristics and adherence to standards was determined by multivariate analysis.

RESULTS

The majority of schools were adhering to the required beverage standards. None of the schools selling competitive foods were 100% adherent to the food standards. Adherence to both standards tended to be highest in food service venues. In univariate analyses, percent nonwhite enrollment, population density, percent free/reduced-price (FRP) meal eligibility, and school size were significantly correlated with the beverage adherence rate. Percent nonwhite enrollment and population density remained significant in the multivariate regression model. Percent nonwhite enrollment and percent FRP meal eligibility were significantly correlated with the food adherence rate in univariate analysis, but neither remained significant in the multiple regression model.

CONCLUSIONS

California high schools are making progress toward implementation of the state nutrition standards. Beverage standards appear easier to achieve than nutrient-based food standards. Additional support is needed to provide schools with resources to implement and monitor these policies. Simpler standards and/or a reduction in the foods and beverages sold could better enable schools to achieve and monitor adherence.