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Shrestha A, Tamrakar D, Ghinanju B, Shrestha D, Khadka P, Adhikari B, Shrestha J, Waiwa S, Pyakurel P, Bhandari N, Karmacharya BM, Shrestha A, Shrestha R, Bhatta RD, Malik V, Mattei J, Spiegelman D. Effects of a dietary intervention on cardiometabolic risk and food consumption in a workplace. PLoS One 2024; 19:e0301826. [PMID: 38656951 PMCID: PMC11042715 DOI: 10.1371/journal.pone.0301826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Worksite-based health programs have shown positive impacts on employee health and have led to significant improvements in cardiovascular risk factor profiles. We aimed to determine the effect of cafeteria intervention on cardio-metabolic risk factors diet in a worksite setting (Dhulikhel Hospital) in Nepal. METHODS In this one-arm pre-post intervention study, we recruited 277 non-pregnant hospital employees aged 18-60 with prediabetes or pre-hypertension. The study was registered in clinicaltrials.gov (NCT03447340; 2018/02/27). All four cafeterias in the hospital premises received cafeteria intervention encouraging healthy foods and discouraging unhealthy foods for six months. We measured blood pressure, fasting glucose level, glycated hemoglobin, cholesterol in the laboratory, and diet intake (in servings per week) using 24-hour recall before and six months after the intervention. The before and after measures were compared using paired-t tests. RESULTS After six months of cafeteria intervention, the median consumption of whole grains, mono/polyunsaturated fat, fruits, vegetable and nuts servings per week increased by 2.24(p<0.001), 2.88(p<0.001), 0.84(p<0.001) 2.25(p<0.001) and nuts 0.55 (p<0.001) servings per week respectively. The median consumption of refined grains decreased by 5.07 servings per week (p<0.001). Mean systolic and diastolic blood pressure decreased by 2 mmHg (SE = 0.6; p = 0.003) and 0.1 mmHg (SE = 0.6; p = 0.008), respectively. The low-density lipoprotein (LDL) was significantly reduced by 6 mg/dL (SE = 1.4; p<0.001). CONCLUSION Overall, we found a decrease in consumption of refined grains and an increase in consumption of whole grains, unsaturated fats, fruits, and nuts observed a modest reduction in blood pressure and LDL cholesterol following a 6-month cafeteria-based worksite intervention incorporating access to healthy foods.
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Affiliation(s)
- Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Dipesh Tamrakar
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
| | - Bhawana Ghinanju
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
| | - Deepa Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
| | - Parashar Khadka
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
| | - Bikram Adhikari
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
| | - Jayana Shrestha
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
| | - Suruchi Waiwa
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
| | - Prajjwal Pyakurel
- Department of Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Koshi, Nepal
| | - Niroj Bhandari
- Department of Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
| | - Biraj Man Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
| | - Akina Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
| | - Rajeev Shrestha
- Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
| | - Rajendra Dev Bhatta
- Department of Biochemistry, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
| | - Vasanti Malik
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Donna Spiegelman
- Department of Biostatistics and Center of Methods for Implementation and Prevention Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
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Schaafsma HN, Jantzi HA, Seabrook JA, McEachern LW, Burke SM, Irwin JD, Gilliland JA. The impact of smartphone app-based interventions on adolescents' dietary intake: a systematic review and evaluation of equity factor reporting in intervention studies. Nutr Rev 2024; 82:467-486. [PMID: 37330675 PMCID: PMC10925905 DOI: 10.1093/nutrit/nuad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023] Open
Abstract
CONTEXT Adolescence is a critical stage for improving nutrition. The popularity of smartphones makes them an ideal platform for administering interventions to adolescents. A systematic review has yet to assess the impact of smartphone app-based interventions exclusively on adolescents' dietary intake. Furthermore, despite the impact of equity factors on dietary intake and the claim for mobile health of increased accessibility, there is minimal research on the reporting of equity factors in the evaluation of smartphone app-based nutrition-intervention research. OBJECTIVES This systematic review examines the effectiveness of smartphone app-based interventions on adolescents' dietary intake and the frequency with which equity factors and statistical analyses specific to equity factors are reported in these intervention studies. DATA SOURCES Databases (ie, Scopus, CINAHL, EMBASE, MEDLINE, PsycINFO, ERIC, and Cochrane Central Register for Randomized Control Trials) were searched for studies published from January 2008 to October 2022. Smartphone app-based intervention studies that were nutrition focused, evaluated at least 1 dietary intake variable, and included participants with a mean age between 10 and 19 years were included. All geographic locations were included. DATA EXTRACTION AND ANALYSIS Study characteristics, intervention results, and reported equity factors were extracted. Because of the heterogeneity of dietary outcomes, findings were reported as a narrative synthesis. CONCLUSION In total, 3087 studies were retrieved, 14 of which met the inclusion criteria. Eleven studies reported a statistically significant improvement in at least 1 dietary outcome because of the intervention. Reporting of at least 1 equity factor across articles' Introduction, Methods, Results, and Discussion sections was minimal (n = 5), and statistical analyses specific to equity factors were rare, occurring in only 4 of the 14 included studies. Future interventions should include a measurement of intervention adherence and report the impact of equity factors on the effectiveness and applicability of interventions for equity-deserving groups.
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Affiliation(s)
- Holly N Schaafsma
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Children’s Health Research Institute, London, Ontario, Canada
| | - Heather A Jantzi
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- Children’s Health Research Institute, London, Ontario, Canada
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Louise W McEachern
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
| | - Shauna M Burke
- Children’s Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jennifer D Irwin
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jason A Gilliland
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
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Donin AS, Goldsmith LP, Sharp C, Wahlich C, Whincup PH, Ussher MH. Identifying barriers and facilitators to increase fibre intakes in UK primary school children and exploring the acceptability of intervention components: a UK qualitative study. Public Health Nutr 2024; 27:e59. [PMID: 38299336 PMCID: PMC10897578 DOI: 10.1017/s1368980024000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/01/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Within the UK, dietary fibre intakes are well below recommended intakes and associated with increased risk of obesity. This study aimed to explore the views of parents and children on barriers and facilitators to increasing fibre intakes and improving diets, alongside investigating the appropriateness of intervention components to overcome modifiable barriers. DESIGN Qualitative study including semi-structured interviews and focus groups informed by the Theoretical Domains Framework (TDF) and the Capability-Opportunity-Motivation-Behaviour (COM-B) model. PARTICIPANTS Year 5 children (aged 9-10-years) and parents, recruited through London primary schools. RESULTS A total of twenty-four participants (eleven parents and thirteen children) took part. Five key themes were identified as barriers and facilitators, namely lack of (and improving) knowledge, social factors (including parent-child conflicts, limited time for food preparation, influence of peer and family members), current eating habits, influence of the school, community and home environment in shaping eating behaviours, and the importance of choice and variety in finding foods that are healthy and tasty. Parents strongly supported school-based dietary interventions to enable consistent messaging at home and school and help support dietary behaviour change. Practical sessions (such as workshops to strengthen knowledge, taste tests and food swap ideas) were supported by parents and children. CONCLUSIONS By using a theory-driven approach to explore the barriers and facilitators to increasing fibre intake, this research identified important themes and modifiable barriers to behaviour change and identifies acceptable intervention components to overcome barriers and bring about sustained dietary behaviour change in primary school children.
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Affiliation(s)
- Angela S Donin
- Population Health Research Institute, St George’s, University of London, LondonSW17 0RE, England, UK
| | - Lucy P Goldsmith
- Population Health Research Institute, St George’s, University of London, LondonSW17 0RE, England, UK
| | - Clare Sharp
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland, UK
| | - Charlotte Wahlich
- Population Health Research Institute, St George’s, University of London, LondonSW17 0RE, England, UK
| | - Peter H Whincup
- Population Health Research Institute, St George’s, University of London, LondonSW17 0RE, England, UK
| | - Michael H Ussher
- Population Health Research Institute, St George’s, University of London, LondonSW17 0RE, England, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland, UK
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Hollis-Hansen K, Haskins C, Turcios J, Bowen ME, Leonard T, Lee M, Albin J, Wadkins-Chambers B, Thompson C, Hall T, Pruitt SL. A pilot randomized controlled trial comparing nutritious meal kits and no-prep meals to improve food security and diet quality among food pantry clients. BMC Public Health 2023; 23:2389. [PMID: 38041070 PMCID: PMC10691040 DOI: 10.1186/s12889-023-17355-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Food pantry clients have high rates of food insecurity and greater risk for and prevalence of diet-related diseases. Many clients face time, resource, and physical constraints that limit their ability to prepare healthy meals using foods typically provided by pantries. We compared two novel approaches to alleviate those barriers and encourage healthier eating: meal kits, which bundle ingredients with a recipe on how to prepare a healthy meal, and nutritious no-prep meals, which can be eaten after thawing or microwaving. METHODS Participants were adult pantry clients from a large food pantry in the Southern sector of Dallas, Texas. We conducted a repeated measures between-subjects study with 70 clients randomized to receive 14-days of meal kits (n = 35) or no-prep meals (n = 35). Participants completed questionnaires at baseline and two-week follow-up on demographics, hedonic liking of study meals, perceived dietary quality, and food security. Two-way repeated measures analysis of variance was used to examine group and time effects, and group by time interactions. We also describe feasibility and satisfaction outcomes to inform future implementation. RESULTS Sixty-six participants completed the study (94%). Participants were predominantly Hispanic or Latino(a) (63%) and African American or Black (31%) women (90%). There was a significant interaction on hedonic liking of study meals (ηp²=0.16, F(1,64) = 11.78, p < .001), such that participants that received meal kits had greater improvements in hedonic liking over time than participants in the no-prep group. We observed significant improvements in perceived dietary quality (ηp²=0.36, F(1,64) = 36.38, p < .001) and food security (ηp²=0.36, F(1,64) = 36.38, p < .001) across both groups over time, but no between group differences or significant interactions indicating one intervention was more effective than the other. Program satisfaction was high across both groups, but higher among the meal kit group (ηp²=0.09, F(1,64) = 6.28, p = .015). CONCLUSIONS Results suggest nutritious meal kits and no-prep meals may be desirable nutrition intervention strategies for pantry clients and have potential to increase food security and perceived dietary quality in the short-term. Our findings are limited by a small sample and short follow-up. Future studies should continue to test both interventions, and include longer follow-up, objective measures of dietary quality, and relevant clinical outcomes. TRIAL REGISTRATION This trial was registered on 25/10/2022 on ClinicalTrials.gov, identifier: NCT05593510.
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Affiliation(s)
- Kelseanna Hollis-Hansen
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US.
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, US.
| | - Carolyn Haskins
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US
| | - Jessica Turcios
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US
| | - Michael E Bowen
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US
- Internal Medicine, UT Southwestern Medical Center, Dallas, TX, US
| | - Tammy Leonard
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, US
| | - MinJae Lee
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, US
| | - Jaclyn Albin
- Pediatrics and Internal Medicine, UT Southwestern Medical Center, Dallas, TX, US
| | | | | | - Taylor Hall
- Crossroads Community Services, Dallas, TX, US
| | - Sandi L Pruitt
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, US
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HomeStyles-2: Randomized controlled trial protocol for a web-based obesity prevention program for families with children in middle childhood. Contemp Clin Trials 2021; 112:106644. [PMID: 34861408 DOI: 10.1016/j.cct.2021.106644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Parents are children's primary role models, are food and physical activity gatekeepers, and create the home structure/lifestyle environment. Thus, parents strongly influence children's weight-related behaviors and have the opportunity to cultivate a "culture of health" within the home. Yet, there is a dearth of evidence-based obesity prevention intervention programs, especially for families with children aged 6-11 years, commonly called middle childhood. METHODS The aim of the HomeStyles-2 online learning mode RCT is to determine whether this novel, age-appropriate, family intervention enables and motivates parents to shape home environments and weight-related lifestyle practices (i.e.,diet, exercise, sleep) to be more supportive of optimal health and reduced obesity risk in middle childhood youth more than those in the control condition. The RCT will include the experimental group and an attention control group. The participants will be parents with school-age children who are systematically randomly assigned by computer to study condition. The HomeStyles intervention is predicated on the social cognitive theory and a social ecological framework. The RCT will collect sociodemographic characteristics of the participant, child, and partner/spouse; child and parent health status; parent weight-related cognitions; weight-related behaviors of the parent and child; and weight-related characteristics of the home environment. Deliverables Enrollment for this study will begin in 2022. DISCUSSION This paper describes these aspects of the HomeStyles-2 intervention: rationale; sample eligibility criteria and recruitment; study design; experimental group intervention theoretical and philosophical underpinnings, structure, content, and development process; attention control intervention; survey instrument development and components; outcome measures; and planned analyses. TRIAL REGISTRATION ClinicalTrials.gov, Protocol #NCT04802291, Registered March 14, 2021.
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Kiew SJ, Majid HA, Mohd Taib NA. A qualitative exploration: Dietary behaviour of Malaysian breast cancer survivors. Eur J Cancer Care (Engl) 2021; 31:e13530. [PMID: 34693588 DOI: 10.1111/ecc.13530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aimed to explore the dietary practices and factors affecting Malaysian breast cancer survivors' dietary behaviours. METHODS We conducted an in-depth qualitative interview on 20 participants from a cohort study. An ecological framework was used to construct the semi-structured topic guide. The interviews were audio-recorded and transcribed verbatim. Thematic analysis with theoretical saturation was used in data analysis. RESULTS The participants were found to have variable dietary practices that either followed or did not follow dietary recommendations. The social environment was critical as most women relied on family and friends for food choices; additionally, individuals in charge of food preparation had to prepare food based on their family member preferences. Furthermore, individuals had difficulty sustaining healthy dietary changes during the acute survivorship phase due to a lack of health consciousness and difficulty in healthy food access. Notably, there was a lack of dietary guidance from health care professionals, especially dietitians, in long-term survivorship care. CONCLUSION This study highlights the lack of breast cancer survivors' healthy diet and lifestyle knowledge. A holistic multidisciplinary approach involving individual, social, physical, and macro-level environmental elements are crucial to influencing healthy eating behaviours.
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Affiliation(s)
- Siew Juan Kiew
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hazreen Abdul Majid
- Centre for Population Health and Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Nutrition, Faculty of Public Health, University of Airlangga, Surabaya, Indonesia
| | - Nur Aishah Mohd Taib
- UM Cancer Research Institute and Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Gillies C, Super S, Te Molder H, de Graaf K, Wagemakers A. Healthy eating strategies for socioeconomically disadvantaged populations: a meta-ethnography. Int J Qual Stud Health Well-being 2021; 16:1942416. [PMID: 34151755 PMCID: PMC8216252 DOI: 10.1080/17482631.2021.1942416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: In developed countries, diet-related health inequalities between people with different levels of socioeconomic advantage persist. However, there is limited qualitative evidence to inform the design of effective healthy eating (HE) strategies in socioeconomically disadvantaged populations (SDPs). The purpose of this review was to explore the characteristics influencing HE strategies for SDPs and develop a new understanding of how and why they influence their success. Methods: A qualitative evidence synthesis using a systematic meta-ethnographic approach. The twelve studies included were conducted in the USA, Canada, Australia, and UK. Results: The studies described a range of HE strategies, including nutrition education programs, food vouchers, and community gardens. Personal values and sense of pride and autonomy were found to have an influence on participants’ attitudes towards HE strategies. Similarly, social characteristics such as level of social support and opportunities for shared benefits influenced participants’ engagement. Structural characteristics such as the affordability and accessibility of healthy foods determined strategy acceptability and success. Finally, organizational characteristics such as flexibility influenced how well strategies supported the circumstances of participants. Conclusions: These overlapping characteristics may be used to inform the development, implementation, and evaluation of strategies to improve healthy eating in SDPs.
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Affiliation(s)
- Christina Gillies
- Strategic Communication Chair Group, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Sabina Super
- Health and Society Chair Group, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Hedwig Te Molder
- Department of Language, Literature, and Communication, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kees de Graaf
- Human Nutrition & Health Chair Group, Department of Agrotechnology and Food Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Annemarie Wagemakers
- Health and Society Chair Group, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
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Roseman MG, Riddell MC, McGee JJ. Kindergarten to 12th Grade School-Based Nutrition Interventions: Putting Past Recommendations Into Practice. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:808-820. [PMID: 32279938 DOI: 10.1016/j.jneb.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 06/11/2023]
Abstract
School-based nutrition interventions are used to improve dietary habits of schoolchildren and reverse trends on obesity. This article reports on kindergarten through 12th grade nutrition interventions published between 2009 and 2018 compared with interventions published between 2000 and 2008 based on (1) behaviorally focused, (2) multicomponent, (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. These 10 recommendations help guide educators, researchers, and nutritionists on more effective nutrition interventions. Future use of implementation science to determine potential drivers of adoption, nonadoption, and effectiveness of the recommendations is encouraged.
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Affiliation(s)
- Mary G Roseman
- Department of Nutrition and Hospitality Management, University of Mississippi, Oxford, MS.
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Trevino A, Cardinal C, Douglas CC. Altered health knowledge and attitudes among health sciences students following media exposure. Nurs Health Sci 2020; 22:967-976. [PMID: 32623789 DOI: 10.1111/nhs.12754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/10/2020] [Accepted: 07/03/2020] [Indexed: 11/27/2022]
Abstract
Communications media that fails to present information supported by evidence-based practice has the potential to adversely influence knowledge and, ultimately, behaviors. We assessed the immediate effect of a health science documentary on knowledge, attitude, and beliefs among collegiate health sciences students enrolled in an entry-level nutrition course using surveys administered online. Participants (n = 160) completed the pre-survey, watched the documentary What the Health, and immediately completed the post-survey in one setting. Compared with pre-survey scores, participants reported a significant decrease in knowledge, change in attitude to health toward regulation of animal products, and increased agreement with all seven, pre-selected contradictory health claims presented in the documentary. Post-documentary, most participants reported they were planning to make a change in their dietary habits to reflect a plant-based diet. Documentaries providing health information contradictory to the current body of scientific literature are persuasive and can potentially increase negative health behaviors. Inclusion of practices within the health curriculum that encourage, and ultimately, improve health literacy among students before entering the health care workforce is essential.
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Affiliation(s)
- Amanda Trevino
- Sam Houston State University, College of Health Sciences, Family and Consumer Sciences, Huntsville, Texas, USA
| | - Christine Cardinal
- Sam Houston State University, College of Health Sciences, Population Health, Huntsville, Texas, USA
| | - Crystal C Douglas
- Sam Houston State University, College of Health Sciences, Family and Consumer Sciences, Huntsville, Texas, USA.,The University of Texas Medical Branch, School of Health Professions, Nutrition & Metabolism, Galveston, Texas, USA
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McKerracher L, Moffat T, Barker M, Williams D, Sloboda DM. Translating the Developmental Origins of Health and Disease concept to improve the nutritional environment for our next generations: a call for a reflexive, positive, multi-level approach. J Dev Orig Health Dis 2019; 10:420-428. [PMID: 31347486 DOI: 10.1017/s2040174418001034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Evidence supporting the Developmental Origins of Health and Disease (DOHaD) hypothesis indicates that improving early life environments can reduce non-communicable disease risks and improve health over the lifecourse. A widespread understanding of this evidence may help to reshape structures, guidelines and individual behaviors to better the developmental conditions for the next generations. Yet, few efforts have yet been made to translate the DOHaD concept beyond the research community. To understand why, and to identify priorities for DOHaD Knowledge Translation (KT) programs, we review here a portion of published descriptions of DOHaD KT efforts and critiques thereof. We focus on KT targeting people equipped to apply DOHaD knowledge to their everyday home or work lives. We identified 17 reports of direct-to-public DOHaD KT that met our inclusion criteria. Relevant KT programs have been or are being initiated in nine countries, most focusing on secondary school students or care-workers-in-training; few target parents-to-be. Early indicators suggest that such programs can empower participants. Main critiques of DOHaD KT suggest it may overburden mothers with responsibility for children's health and health environments, minimizing the roles of other people and institutions. Simultaneously, though, many mothers-to-be seek reliable guidance on prenatal health and nutrition, and would likely benefit from engagement with DOHaD KT. We thus recommend emphasizing solidarity, and bringing together people likely to one day become parents (youth), people planning pregnancies, expecting couples, care workers and policymakers into empowering conversation about DOHaD and about the importance and complexity of early life environments.
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Affiliation(s)
- L McKerracher
- Department of Biochemistry and Biomedical Sciences, McMaster University,Hamilton, ON,Canada
| | - T Moffat
- Department of Anthropology, McMaster University,Hamilton, ON,Canada
| | - M Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton,Southampton,UK
| | - D Williams
- Department of Anthropology, McMaster University,Hamilton, ON,Canada
| | - D M Sloboda
- Department of Biochemistry and Biomedical Sciences, McMaster University,Hamilton, ON,Canada
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Colley P, Myer B, Seabrook J, Gilliland J. The Impact of Canadian School Food Programs on Children’s Nutrition and Health: A Systematic Review. CAN J DIET PRACT RES 2019; 80:79-86. [DOI: 10.3148/cjdpr-2018-037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The quality of children’s diets has declined over the past few decades, giving rise to a variety of health-related consequences. In response to this trend, school food programs have become an increasingly effective method to support nutrition and lifelong healthy eating habits. This systematic review synthesizes current academic literature pertaining to school nutrition programs in Canada to identify existing interventions and their impacts on children’s nutritional knowledge, dietary behaviour, and food intake. The review was conducted through a search of the following databases: ERIC, Education Source, CINAHL, PubMed, SagePub, SCOPUS, EMBASE, and CBCA. Information extracted from the articles included the program objectives, intervention design and components, research evaluation, and primary outcomes. A total of 11 articles evaluating Canadian school nutrition programs were identified. The programs incorporated a variety of intervention components including policy, education, family and community involvement, and/or food provision. These multi-component interventions were positively associated with children’s development of nutrition knowledge, dietary behaviour changes, and intake of healthy foods; however, barriers associated with intervention duration, intensity, and availability of resources may have influenced the extent to which these programs impacted children’s diets and overall health.
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Affiliation(s)
- Paige Colley
- Health and Rehabilitation Sciences, Western University, London, ON
| | - Bronia Myer
- Medical Sciences and Psychology, Western University, London, ON
| | - Jamie Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, ON
- Department of Paediatrics and Epidemiology & Biostatistics, Western University, London, ON
| | - Jason Gilliland
- Department of Geography, Health Studies, Paediatrics, and Epidemiology & Biostatistics, Western University, London, ON
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Harst L, Lantzsch H, Scheibe M. Theories Predicting End-User Acceptance of Telemedicine Use: Systematic Review. J Med Internet Res 2019; 21:e13117. [PMID: 31115340 PMCID: PMC6547771 DOI: 10.2196/13117] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/08/2019] [Accepted: 03/29/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Only a few telemedicine applications have made their way into regular care. One reason is the lack of acceptance of telemedicine by potential end users. OBJECTIVE The aim of this systematic review was to identify theoretical predictors that influence the acceptance of telemedicine. METHODS An electronic search was conducted in PubMed and PsycINFO in June 2018 and supplemented by a hand search. Articles were identified using predefined inclusion and exclusion criteria. In total, two reviewers independently assessed the title, abstract, and full-text screening and then individually performed a quality assessment of all included studies. RESULTS Out of 5917 potentially relevant titles (duplicates excluded), 24 studies were included. The Axis Tool for quality assessment of cross-sectional studies revealed a high risk of bias for all studies except for one study. The most commonly used models were the Technology Acceptance Model (n=11) and the Unified Theory of Acceptance and Use of Technology (n=9). The main significant predictors of acceptance were perceived usefulness (n=11), social influences (n=6), and attitude (n=6). The results show a superiority of technology acceptance versus original behavioral models. CONCLUSIONS The main finding of this review is the applicability of technology acceptance models and theories on telemedicine adoption. Characteristics of the technology, such as its usefulness, as well as attributes of the individual, such as his or her need for social support, inform end-user acceptance. Therefore, in the future, requirements of the target group and the group's social environment should already be taken into account when planning telemedicine applications. The results support the importance of theory-guided user-centered design approaches to telemedicine development.
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Affiliation(s)
- Lorenz Harst
- Research Association Public Health, Center of Evidence-based Healthcare, University Clinic Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Hendrikje Lantzsch
- Master Program Health Sciences / Public Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Madlen Scheibe
- Center for Evidence-Based Healthcare, University Clinic Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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13
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Eck KM, Delaney CL, Olfert MD, Shelnutt KP, Byrd-Bredbenner C. "If my family is happy, then I am happy": Quality-of-life determinants of parents of school-age children. SAGE Open Med 2019; 7:2050312119828535. [PMID: 30746145 PMCID: PMC6360638 DOI: 10.1177/2050312119828535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/14/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Obesity is a public health concern for children and adults and effective obesity prevention programming is needed urgently. The effectiveness of health-related messaging and interventions is influenced by the way content is framed. HomeStyles is an obesity prevention program, which aims to promote health through the frame of improved quality of life. METHODS Thus, focus groups were conducted with English- and Spanish-speaking parents of school-aged children (ages 6-11) to identify key quality-of-life determinants as described by parents. RESULTS Parents (n = 158) reported that their quality of life was influenced by family happiness and parent and child health (e.g. adequate sleep, exercise, healthy diet). Many parents expressed that their busy schedules and lack of family time were detrimental to their quality of life. Work-life balance and financial stability were other factors commonly noted to impact quality of life. Spanish-speaking parents also reported being undocumented and feeling a lack of a sense of community negatively influenced their quality of life. CONCLUSION Considering parent-defined quality-of-life determinants when framing health-related messaging and developing interventions may increase participant interest and ultimately improve health-related behaviors. Next steps in the HomeStyles project include using parent-reported quality-of-life determinants to guide the development of intervention materials.
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Affiliation(s)
- Kaitlyn M Eck
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Colleen L Delaney
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Melissa D Olfert
- Department of Animal and Nutritional Sciences, West Virginia University, Morgantown, WV, USA
| | - Karla P Shelnutt
- Department of Family, Youth and Community Sciences, University of Florida, Gainesville, FL, USA
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Browne S, Minozzi S, Bellisario C, Sweeney MR, Susta D. Effectiveness of interventions aimed at improving dietary behaviours among people at higher risk of or with chronic non-communicable diseases: an overview of systematic reviews. Eur J Clin Nutr 2018; 73:9-23. [PMID: 30353122 DOI: 10.1038/s41430-018-0327-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/01/2018] [Accepted: 09/12/2018] [Indexed: 12/20/2022]
Abstract
Programmes that promote dietary behaviour change for the prevention of chronic disease must include components that are rooted in best practice and associated with effectiveness. The purpose of this overview of systematic reviews was to examine the characteristics and dietary behaviour change outcomes of nutrition interventions among populations with or at risk of non-communicable chronic diseases. Systematic reviews of randomised controlled trials (RCTs) testing dietary behaviour change interventions published between January 2006 and November 2015 were identified via searches in Cochrane Library, PubMed, EMBASE and PsycINFO. Quality of reviews were appraised using AMSTAR. Dietary behaviour change and intervention details were extracted and systematically summarised. Fifteen articles met the inclusion criteria. Dietary behaviour changes in response to nutrition interventions were significant in over half of interventions. Reducing dietary fat and increasing fruits and vegetables were the most common behaviour changes. The characteristics of nutrition interventions and their relationship to effectiveness for dietary behaviour change among chronic disease or at-risk populations were reported inconsistently. However, associative evidence exists to support more frequent contacts and the use of specific behaviour change techniques. No clear relationships were found between effectiveness and intervention setting, mode of delivery or intervention provider, although some population-specific relationships were identified. Interventions that promote long-term maintenance of dietary behaviour changes are lacking in the literature. This comprehensive umbrella review identifies specific characteristics of interventions that are associated with effectiveness in interventions that promote dietary behaviour change among different at-risk populations. In order to maximise outcomes, public health, health promotion and healthcare organisations should consider these results in order to inform the development and improvement of nutrition programmes.
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Affiliation(s)
- Sarah Browne
- School Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Silvia Minozzi
- Universita' del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Cristina Bellisario
- Universita' del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Mary Rose Sweeney
- School Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Davide Susta
- School Health & Human Performance, Dublin City University, Dublin, Ireland.
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Wolfe WS, Scott-Pierce M, Dollahite J. Choose Health: Food, Fun, and Fitness Youth Curriculum Promotes Positive Behaviors. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:924-930. [PMID: 29170056 DOI: 10.1016/j.jneb.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 09/14/2017] [Accepted: 09/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Evaluate whether participation in Choose Health: Food, Fun, and Fitness (CHFFF), a hands-on, experiential curriculum aimed at third- to sixth-graders, resulted in improvements in the targeted obesity and chronic disease prevention behaviors. METHODS The researchers evaluated CHFFF in low-income youth participating in 2 federal programs in New York State during 2013-2015. Food and activity behaviors were assessed using the Expanded Food and Nutrition Education Program third- through fifth- and sixth- through eighth-grade pre-post surveys, along with 2 sets of added CHFFF-specific items completed by subsamples. Educators trained in CHFFF had youth complete the surveys as they delivered the curriculum, primarily in schools and after-school programs. RESULTS Paired t tests showed significant (P < .01) positive changes before to after CHFFF education for consumption of vegetables, fruits, sweetened drinks, nutrition label reading, and other food and activity behaviors. CONCLUSIONS AND IMPLICATIONS Results provide practice-based evidence that CHFFF promotes positive behavior change in participating youth.
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Affiliation(s)
- Wendy S Wolfe
- Division of Nutritional Sciences, Cornell University, Ithaca, NY.
| | | | - Jamie Dollahite
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
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16
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Quick V, Martin-Biggers J, Povis GA, Worobey J, Hongu N, Byrd-Bredbenner C. Long-term follow-up effects of the HomeStyles randomized controlled trial in families with preschool children on social cognitive theory constructs associated with physical activity cognitions and behaviors. Contemp Clin Trials 2018; 68:79-89. [DOI: 10.1016/j.cct.2018.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/01/2018] [Accepted: 03/12/2018] [Indexed: 12/19/2022]
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Promoting healthy home environments and lifestyles in families with preschool children: HomeStyles, a randomized controlled trial. Contemp Clin Trials 2017; 64:139-151. [PMID: 29079392 DOI: 10.1016/j.cct.2017.10.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/12/2017] [Accepted: 10/23/2017] [Indexed: 11/22/2022]
Abstract
The purpose of the HomeStyles randomized controlled trial was to determine the effect of participation in the HomeStyles intervention vs an attention control condition on the weight-related aspects of the home environment and lifestyle behavioral practices of families with preschool children. Parents of preschool children (n=489) were systematically randomized to experimental or attention control group after completing the baseline survey. Baseline and post surveys comprehensively assessed study outcomes using a socio-ecological approach incorporating valid, reliable intrapersonal (e.g., diet, activity), interpersonal (e.g., family meal frequency), and environmental measures (e.g., home media environment), and self-reported parent and child measured heights and weights. For all outcome measures, paired t-tests compared within group differences over time and ANCOVA, controlling for baseline scores and prognostic variables (e.g., parent sex), determined differences in post survey scores between groups. The final analytical sample (N=172; age 32.34±5.71SD; 58% White; 93% female) completed baseline and post surveys. The experimental group families had improved family meal and diet-related behaviors, and self-efficacy for food-related childhood obesity-protective practices. Household food supplies changed little, except for less availability of salty/fatty snacks. Within group effects indicated the control group also experienced some improvements, however these were few in number. ANCOVA revealed the experimental group parents had greater physical activity, reduced screentime, improved family mealtime behaviors, and increased self-efficacy for childhood obesity-protective behaviors and cognitions compared to the control group at post survey, though effect sizes were small. The HomeStyles program for families with preschool children promoted improvements in an array of obesity-preventive behaviors.
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Quick V, Martin-Biggers J, Povis GA, Hongu N, Worobey J, Byrd-Bredbenner C. A Socio-Ecological Examination of Weight-Related Characteristics of the Home Environment and Lifestyles of Households with Young Children. Nutrients 2017; 9:nu9060604. [PMID: 28613270 PMCID: PMC5490583 DOI: 10.3390/nu9060604] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 11/24/2022] Open
Abstract
Home environment and family lifestyle practices have an influence on child obesity risk, thereby making it critical to systematically examine these factors. Thus, parents (n = 489) of preschool children completed a cross-sectional online survey which was the baseline data collection conducted, before randomization, in the HomeStyles program. The survey comprehensively assessed these factors using a socio-ecological approach, incorporating intrapersonal, interpersonal and environmental measures. Healthy intrapersonal dietary behaviors identified were parent and child intakes of recommended amounts of 100% juice and low intakes of sugar-sweetened beverages. Unhealthy behaviors included low milk intake and high parent fat intake. The home environment’s food supply was found to support healthy intakes of 100% juice and sugar-sweetened beverages, but provided too little milk and ample quantities of salty/fatty snacks. Physical activity levels, sedentary activity and the home’s physical activity and media environment were found to be less than ideal. Environmental supports for active play inside homes were moderate and somewhat better in the area immediately outside homes and in the neighborhood. Family interpersonal interaction measures revealed several positive behaviors, including frequent family meals. Parents had considerable self-efficacy in their ability to perform food- and physical activity-related childhood obesity protective practices. This study identified lifestyle practices and home environment characteristics that health educators could target to help parents promote optimal child development and lower their children’s risk for obesity.
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Affiliation(s)
- Virginia Quick
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
| | - Jennifer Martin-Biggers
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
| | - Gayle Alleman Povis
- Department of Nutritional Sciences, University of Arizona, 406 Shantz Building, 1177 E. 4th Street, Tucson, AZ 85721, USA.
| | - Nobuko Hongu
- Department of Nutritional Sciences, University of Arizona, 406 Shantz Building, 1177 E. 4th Street, Tucson, AZ 85721, USA.
| | - John Worobey
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
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19
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Zhang FF, Meagher S, Scheurer M, Folta S, Finnan E, Criss K, Economos C, Dreyer Z, Kelly M. Developing a Web-Based Weight Management Program for Childhood Cancer Survivors: Rationale and Methods. JMIR Res Protoc 2016; 5:e214. [PMID: 27864163 PMCID: PMC5135730 DOI: 10.2196/resprot.6381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/18/2016] [Accepted: 10/07/2016] [Indexed: 12/13/2022] Open
Abstract
Background Due to advances in the field of oncology, survival rates for children with cancer have improved significantly. However, these childhood cancer survivors are at a higher risk for obesity and cardiovascular diseases and for developing these conditions at an earlier age. Objective In this paper, we describe the rationale, conceptual framework, development process, novel components, and delivery plan of a behavioral intervention program for preventing unhealthy weight gain in survivors of childhood acute lymphoblastic leukemia (ALL). Methods A Web-based program, the Healthy Eating and Active Living (HEAL) program, was designed by a multidisciplinary team of researchers who first identified behaviors that are appropriate targets for weight management in childhood ALL survivors and subsequently developed the intervention components, following core behavioral change strategies grounded in social cognitive and self-determination theories. Results The Web-based HEAL curriculum has 12 weekly self-guided sessions to increase parents’ awareness of the potential impact of cancer treatment on weight and lifestyle habits and the importance of weight management in survivors’ long-term health. It empowers parents with knowledge and skills on parenting, nutrition, and physical activity to help them facilitate healthy eating and active living soon after the child completes intensive cancer treatment. Based on social cognitive theory, the program is designed to increase behavioral skills (goal-setting, self-monitoring, and problem-solving) and self-efficacy and to provide positive reinforcement to sustain behavioral change. Conclusions Lifestyle interventions are a priority for preventing the early onset of obesity and cardiovascular risk factors in childhood cancer survivors. Intervention programs need to meet survivors’ targeted behavioral needs, address specific barriers, and capture a sensitive window for behavioral change. In addition, they should be convenient, cost-effective and scalable. Future studies are needed to evaluate the feasibility of introducing weight management early in cancer care and the efficacy of early weight management on survivors’ health outcomes.
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Affiliation(s)
- Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | | | | | - Sara Folta
- Tufts University, Boston, MA, United States
| | | | | | | | - ZoAnn Dreyer
- Baylor College of Medicine, Houston, TX, United States
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Geaney F, Kelly C, Di Marrazzo JS, Harrington JM, Fitzgerald AP, Greiner BA, Perry IJ. The effect of complex workplace dietary interventions on employees' dietary intakes, nutrition knowledge and health status: a cluster controlled trial. Prev Med 2016; 89:76-83. [PMID: 27208667 DOI: 10.1016/j.ypmed.2016.05.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/13/2016] [Accepted: 05/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evidence on effective workplace dietary interventions is limited. The comparative effectiveness of a workplace environmental dietary modification and an educational intervention both alone and in combination was assessed versus a control workplace on employees' dietary intakes, nutrition knowledge and health status. METHODS In the Food Choice at Work cluster controlled trial, four large, purposively selected manufacturing workplaces in Ireland were allocated to control (N=111), nutrition education (Education) (N=226), environmental dietary modification (Environment) (N=113) and nutrition education and environmental dietary modification (Combined) (N=400) in 2013. Nutrition education included group presentations, individual consultations and detailed nutrition information. Environmental dietary modification included menu modification, fruit price discounts, strategic positioning of healthier alternatives and portion size control. Data on dietary intakes, nutrition knowledge and health status were obtained at baseline and follow-up at 7-9months. Multivariate analysis of covariance compared changes across the four groups with adjustment for age, gender, educational status and other baseline characteristics. RESULTS Follow-up data at 7-9months were obtained for 541 employees (64% of 850 recruited) aged 18-64years: control: 70 (63%), Education: 113 (50%), ENVIRONMENT 74 (65%) and Combined: 284 (71%). There were significant positive changes in intakes of saturated fat (p=0.013), salt (p=0.010) and nutrition knowledge (p=0.034) between baseline and follow-up in the combined intervention versus the control. Small but significant changes in BMI (-1.2kg/m(2) (95% CI -2.385, -0.018, p=0.047) were observed in the combined intervention. Effects in the education and environment alone workplaces were smaller and generally non-significant. CONCLUSION Combining nutrition education and environmental dietary modification may be an effective approach for promoting a healthy diet and weight loss at work.
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Affiliation(s)
- Fiona Geaney
- Department of Epidemiology and Public Health, University College Cork, 4th Floor, Western Gateway Building, Western Road, Cork, Republic of Ireland.
| | - Clare Kelly
- Department of Epidemiology and Public Health, University College Cork, 4th Floor, Western Gateway Building, Western Road, Cork, Republic of Ireland
| | - Jessica Scotto Di Marrazzo
- Department of Epidemiology and Public Health, University College Cork, 4th Floor, Western Gateway Building, Western Road, Cork, Republic of Ireland
| | - Janas M Harrington
- Department of Epidemiology and Public Health, University College Cork, 4th Floor, Western Gateway Building, Western Road, Cork, Republic of Ireland
| | - Anthony P Fitzgerald
- Department of Epidemiology and Public Health, University College Cork, 4th Floor, Western Gateway Building, Western Road, Cork, Republic of Ireland
| | - Birgit A Greiner
- Department of Epidemiology and Public Health, University College Cork, 4th Floor, Western Gateway Building, Western Road, Cork, Republic of Ireland
| | - Ivan J Perry
- Department of Epidemiology and Public Health, University College Cork, 4th Floor, Western Gateway Building, Western Road, Cork, Republic of Ireland
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Horodyska K, Luszczynska A, Hayes CB, O'Shea MP, Langøien LJ, Roos G, van den Berg M, Hendriksen M, De Bourdeaudhuij I, Brug J. Implementation conditions for diet and physical activity interventions and policies: an umbrella review. BMC Public Health 2015; 15:1250. [PMID: 26678996 PMCID: PMC4683715 DOI: 10.1186/s12889-015-2585-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 12/08/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This umbrella review aimed at identifying evidence-based conditions important for successful implementation of interventions and policies promoting a healthy diet, physical activity (PA), and a reduction in sedentary behaviors (SB). In particular, we examined if the implementation conditions identified were intervention-specific or policy-specific. This study was undertaken as part of the DEterminants of DIet and Physical Activity (DEDIPAC) Knowledge Hub, a joint action as part of the European Joint Programming Initiative a Healthy Diet for a Healthy Life. METHODS A systematic review of reviews and stakeholder documents was conducted. Data from nine scientific literature databases were analyzed (95 documents met the inclusion criteria). Additionally, published documentation of eight major stakeholders (e.g., World Health Organization) were systematically searched (17 documents met the inclusion criteria). The RE-AIM framework was used to categorize elicited conditions. Across the implementation conditions 25 % were identified in at least four documents and were subsequently classified as having obtained sufficient support. RESULTS We identified 312 potential conditions relevant for successful implementation; 83 of these received sufficient support. Using the RE-AIM framework eight implementation conditions that obtained support referred to the reach in the target population; five addressed efficacy of implementation processes; 24 concerned adoption by the target staff, setting, or institutions; 43 referred to consistency, costs, and adaptations made in the implementation process; three addressed maintenance of effects over time. The vast majority of implementation conditions (87.9 %; 73 of 83) were supported by documents referring to both interventions and policies. There were seven policy-specific implementation conditions, which focused on increasing complexities of coexisting policies/legal instruments and their consequences for implementation, as well as politicians' collaboration in implementation. CONCLUSIONS The use of the proposed list of 83 conditions for successful implementation may enhance the implementation of interventions and policies which pursue identification of the most successful actions aimed at improving diet, PA and reducing SB.
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Affiliation(s)
- Karolina Horodyska
- Department of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego St, 53238, Wroclaw, Poland.
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego St, 53238, Wroclaw, Poland.
- Trauma, Health, & Hazards Center, University of Colorado, 1861 Austin Bluffs Pkwy, Colorado Springs, CO, 80933-7150, USA.
| | - Catherine B Hayes
- Department of Public Health and Primary Care, Trinity College Dublin, Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
| | - Miriam P O'Shea
- Department of Public Health and Primary Care, Trinity College Dublin, Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
| | - Lars J Langøien
- Department for Physical Education, Norwegian School of Sport Sciences, P.O. BOX 4014, Ullevål Stadion, N-0806, Oslo, Norway.
| | - Gun Roos
- SIFO - National Institute for Consumer Research, P.O. BOX 4682, Nydalen, N-0405, Oslo, Norway.
| | - Matthijs van den Berg
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721, Bilthoven, The Netherlands.
| | - Marieke Hendriksen
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721, Bilthoven, The Netherlands.
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium.
| | - Johannes Brug
- VU University Medical Center, Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Martin-Biggers J, Spaccarotella K, Delaney C, Koenings M, Alleman G, Hongu N, Worobey J, Byrd-Bredbenner C. Development of the Intervention Materials for the HomeStyles Obesity Prevention Program for Parents of Preschoolers. Nutrients 2015; 7:6628-69. [PMID: 26266419 PMCID: PMC4555140 DOI: 10.3390/nu7085301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/20/2015] [Accepted: 07/30/2015] [Indexed: 12/12/2022] Open
Abstract
Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles) with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith's Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251) and content (n = 261) occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial.
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Affiliation(s)
- Jennifer Martin-Biggers
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue New Brunswick, NJ 08901, USA; E-Mails: (J.M.-B.); (C.D.); (M.K.); (J.W.)
| | - Kim Spaccarotella
- Department of Biological Sciences, Kean University, 1000 Morris Avenue Union, NJ 07082, USA; E-Mail:
| | - Colleen Delaney
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue New Brunswick, NJ 08901, USA; E-Mails: (J.M.-B.); (C.D.); (M.K.); (J.W.)
| | - Mallory Koenings
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue New Brunswick, NJ 08901, USA; E-Mails: (J.M.-B.); (C.D.); (M.K.); (J.W.)
| | - Gayle Alleman
- Department of Nutritional Sciences, University of Arizona, 406 Shantz Building, 1177 E. 4th Street, Tucson, AZ 85721-0038, USA; E-Mails: (G.A.); (N.H.)
| | - Nobuko Hongu
- Department of Nutritional Sciences, University of Arizona, 406 Shantz Building, 1177 E. 4th Street, Tucson, AZ 85721-0038, USA; E-Mails: (G.A.); (N.H.)
| | - John Worobey
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue New Brunswick, NJ 08901, USA; E-Mails: (J.M.-B.); (C.D.); (M.K.); (J.W.)
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue New Brunswick, NJ 08901, USA; E-Mails: (J.M.-B.); (C.D.); (M.K.); (J.W.)
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Schembri L, Curran J, Collins L, Pelinovskaia M, Bell H, Richardson C, Palermo C. The effect of nutrition education on nutrition-related health outcomes of Aboriginal and Torres Strait Islander people: a systematic review. Aust N Z J Public Health 2015; 40 Suppl 1:S42-7. [PMID: 26123037 DOI: 10.1111/1753-6405.12392] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/01/2014] [Accepted: 02/01/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of nutrition education on improving nutrition-related health outcomes in Aboriginal and Torres Strait Islander people. METHODS Databases Medline, Cinahl, Scopus, ProQuest and ATSI Health were searched in September 2013 to identify nutrition education intervention studies in Indigenous Australian populations. Peer-reviewed and grey literature with nutrition-related biochemical or anthropometrical health outcomes were included in a qualitative comparative analysis. RESULTS Of 1,162 studies identified from the search, six met inclusion criteria. Three studies were from a remote setting and three from an urban setting. Four of the six education interventions were shown to improve body mass index (BMI) and/or nutritional biochemical indicators. Components of the nutrition education interventions showing greatest effect included cooking skills workshops, group education sessions and store interventions. Community involvement in the program design was most strongly associated with a positive effect on BMI. CONCLUSION Nutrition education had some effect in reducing biochemical and anthropometric risk factors for chronic disease in Indigenous Australians. IMPLICATIONS Nutrition education can be considered as part of a range of strategies to improve nutrition-related health for Aboriginal and Torres Strait Islander people. Further evidence is needed to strengthen this recommendation.
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Affiliation(s)
- Laura Schembri
- Department of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria
| | - Johannah Curran
- Department of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria
| | - Lyndal Collins
- Department of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria
| | - Marta Pelinovskaia
- Department of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria
| | - Hayley Bell
- Department of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria
| | - Christina Richardson
- Department of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria
| | - Claire Palermo
- Department of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria
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Translating it into real life: a qualitative study of the cognitions, barriers and supports for key obesogenic behaviors of parents of preschoolers. BMC Public Health 2015; 15:189. [PMID: 25886030 PMCID: PMC4355499 DOI: 10.1186/s12889-015-1554-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/16/2015] [Indexed: 01/16/2023] Open
Abstract
Background Little is known about preschool parents’ cognitions, barriers, supports and modeling of key obesogenic behaviors, including breakfast, fruit and vegetable consumption, sugary beverage intake, feeding practices, portion sizes, active playtime, reduced screen-time, sleep and selection of child-care centers with characteristics that promote healthy behaviors. Methods Thus, the purpose of this study was to examine these factors via survey and focus groups among 139 parents of 2- to 5-year-old children. Standard content analysis procedures were used to identify trends and themes in the focus group data, and Analysis of Variance was used to test for differences between groups in the survey data. Results Results showed 80% of parents ate breakfast daily, consumed sugary beverages 2.7 ± 2.5SD days per week, and had at least two different vegetables and fruits an average of 5.2 ± 1.8SD and 4.6 ± 2.0SD days per week. Older parents and those with greater education drank significantly fewer sugary drinks. Parents played actively a mean 4.2 ± 2.2 hours/week with their preschoolers, who watched television a mean 2.4 ± 1.7 hours/day. Many parents reported having a bedtime routine for their preschooler and choosing childcare centers that replaced screen-time with active play and nutrition education. Common barriers to choosing healthful behaviors included lack of time; neighborhood safety; limited knowledge of portion size, cooking methods, and ways to prepare healthy foods or play active indoor games; the perceived cost of healthy options, and family members who were picky eaters. Supports for performing healthful behaviors included planning ahead, introducing new foods and behaviors often and in tandem with existing preferred foods and behaviors, and learning strategies from other parents. Conclusions Future education programs with preschool parents should emphasize supports and encourage parents to share helpful strategies with each other.
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Dudley DA, Cotton WG, Peralta LR. Teaching approaches and strategies that promote healthy eating in primary school children: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2015; 12:28. [PMID: 25889098 PMCID: PMC4416340 DOI: 10.1186/s12966-015-0182-8] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/03/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Healthy eating by primary school-aged children is important for good health and development. Schools can play an important role in the education and promotion of healthy eating among children. The aim of this review was to: 1) perform a systematic review of randomised controlled, quasi-experimental and cluster controlled trials examining the school-based teaching interventions that improve the eating habits of primary school children; and 2) perform a meta-analysis to determine the effect of those interventions. METHODS The systematic review was limited to four healthy eating outcomes: reduced food consumption or energy intake; increased fruit and vegetable consumption or preference; reduced sugar consumption or preference (not from whole fruit); increased nutritional knowledge. In March 2014, we searched seven electronic databases using predefined keywords for intervention studies that were conducted in primary schools which focused on the four healthy eating outcomes. Targeted internet searching using Google Scholar was also used. In excess of 200,000 possible citations were identified. Abstracts and full text of articles of potentially relevant papers were screened to determine eligibility. Data pertaining to teaching strategies that reported on healthy eating outcomes for primary school children was extracted from the 49 eligible papers. RESULTS Experiential learning strategies were associated with the largest effects across the reduced food consumption or energy intake; increased fruit and vegetable consumption or preference; and increased nutritional knowledge outcomes. Reducing sugar consumption and preference was most influenced by cross-curricular approaches embedded in the interventions. CONCLUSIONS As with most educational interventions, most of the teaching strategies extracted from the intervention studies led to positive changes in primary school children's healthy eating behaviours. However, given the finite resources, increased overcrowding of school curriculum and capacity of teachers in primary schools, a meta-analysis of this scope is able to provide stakeholders with the best evidence of where these resources should be focused.
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Affiliation(s)
- Dean A Dudley
- School of Education, Faculty of Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Wayne G Cotton
- Faculty of Education and Social Work, University of Sydney, Sydney, NSW, Australia.
| | - Louisa R Peralta
- Faculty of Education and Social Work, University of Sydney, Sydney, NSW, Australia.
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Bhopal RS, Douglas A, Wallia S, Forbes JF, Lean MEJ, Gill JMR, McKnight JA, Sattar N, Sheikh A, Wild SH, Tuomilehto J, Sharma A, Bhopal R, Smith JBE, Butcher I, Murray GD. Effect of a lifestyle intervention on weight change in south Asian individuals in the UK at high risk of type 2 diabetes: a family-cluster randomised controlled trial. Lancet Diabetes Endocrinol 2014; 2:218-27. [PMID: 24622752 DOI: 10.1016/s2213-8587(13)70204-3] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The susceptibility to type 2 diabetes of people of south Asian descent is established, but there is little trial-based evidence for interventions to tackle this problem. We assessed a weight control and physical activity intervention in south Asian individuals in the UK. METHODS We did this non-blinded trial in two National Health Service (NHS) regions in Scotland (UK). Between July 1, 2007, and Oct 31, 2009, we recruited men and women of Indian and Pakistani origin, aged 35 years or older, with waist circumference 90 cm or greater in men or 80 cm or greater in women, and with impaired glucose tolerance or impaired fasting glucose determined by oral glucose tolerance test. Families were randomised (using a random number generator program, with permuted blocks of random size, stratified by location [Edinburgh or Glasgow], ethnic group [Indian or Pakistani], and number of participants in the family [one vs more than one]) to intervention or control. Participants in the same family were not randomised separately. The intervention group received 15 visits from a dietitian over 3 years and the control group received four visits in the same period. The primary outcome was weight change at 3 years. Analysis was by modified intention to treat, excluding participants who died or were lost to follow-up. We used linear regression models to provide mean differences in baseline-adjusted weight at 3 years. This trial is registered, number ISRCTN25729565. FINDINGS Of 1319 people who were screened with an oral glucose tolerance test, 196 (15%) had impaired glucose tolerance or impaired fasting glucose and 171 entered the trial. Participants were in 156 family clusters that were randomised (78 families with 85 participants were allocated to intervention; 78 families with 86 participants were allocated to control). 167 (98%) participants in 152 families completed the trial. Mean weight loss in the intervention group was 1.13 kg (SD 4.12), compared with a mean weight gain of 0.51 kg (3.65) in the control group, an adjusted mean difference of -1.64 kg (95% CI -2.83 to -0.44). INTERPRETATION Modest, medium-term changes in weight are achievable as a component of lifestyle-change strategies, which might control or prevent adiposity-related diseases. FUNDING National Prevention Research Initiative, NHS Research and Development; NHS National Services Scotland; NHS Health Scotland.
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Affiliation(s)
- Raj S Bhopal
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
| | - Anne Douglas
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Sunita Wallia
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - John F Forbes
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Michael E J Lean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John A McKnight
- Metabolic Unit, Anne Ferguson Building, Western General Hospital, Edinburgh, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Aziz Sheikh
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah H Wild
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Jaakko Tuomilehto
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria; Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anu Sharma
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Ruby Bhopal
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Joel B E Smith
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Isabella Butcher
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Gordon D Murray
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Huye HF, Connell CL, Crook LB, Yadrick K, Zoellner J. Using the RE-AIM Framework in formative evaluation and program planning for a nutrition intervention in the Lower Mississippi Delta. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:34-42. [PMID: 24188802 DOI: 10.1016/j.jneb.2013.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 09/03/2013] [Accepted: 09/14/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Identification of prominent themes to be considered when planning a nutrition intervention using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. DESIGN Qualitative formative research. SETTING Women's social and civic organizations in the Lower Mississippi Delta. PARTICIPANTS Thirty-seven (5 white and 32 black) women with a college degree or higher. PHENOMENON OF INTEREST Impact of dietary and contextual factors related to the Lower Mississippi Delta culture on intervention planning. ANALYSIS Case analysis strategy using question-by-question coding. RESULTS Major themes that emerged were "healthy eating focus" and "promoting a healthy lifestyle" when recruiting organizations (Reach); "positive health changes" as a result of the intervention (Effectiveness); "logistics: time commitment, location, and schedule" to initiate a program (Adoption); "expense of healthy foods" and "cooking and meal planning" as barriers to participation (Implementation); and "resources and training" and "motivation" as necessary for program continuation (Maintenance). The "health of the Delta" theme was found across all dimensions, which reflected participants' compassion for their community. CONCLUSIONS AND IMPLICATIONS Results were used to develop an implementation plan promoting optimal reach, effectiveness, adoption, implementation, and maintenance of a nutrition intervention. This research emphasizes the benefits of formative research using a systematic process at organizational and individual levels.
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Affiliation(s)
- Holly F Huye
- Department of Nutrition and Food Systems, University of Southern Mississippi, Hattiesburg, MS.
| | - Carol L Connell
- Department of Nutrition and Food Systems, University of Southern Mississippi, Hattiesburg, MS
| | - LaShaundrea B Crook
- Department of Nutrition and Food Systems, University of Southern Mississippi, Hattiesburg, MS
| | - Kathy Yadrick
- Department of Nutrition and Food Systems, University of Southern Mississippi, Hattiesburg, MS
| | - Jamie Zoellner
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
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Gates M, Hanning RM, Gates A, Isogai A, Tsuji LJS, Metatawabin J. A pilot comprehensive school nutrition program improves knowledge and intentions for intake of milk and milk alternatives among youth in a remote first nation. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2013; 45:455-459. [PMID: 23414784 DOI: 10.1016/j.jneb.2012.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 10/20/2012] [Accepted: 12/03/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the impact of a pilot comprehensive school nutrition program modeled on Social Cognitive Theory on knowledge, intentions, self-efficacy, and intake of milk and milk alternatives (MMA) in First Nations youth. METHODS A pilot school nutrition program was implemented at Peetabeck Academy in Fort Albany, Ontario in May, 2010. The Knowledge, Self-Efficacy, and Intentions Questionnaire (KSIQ) and Waterloo Web-based Eating Behavior Questionnaire (WEB-Q) were used to assess change in attitudes and behavior from pre- to postprogram. RESULTS The KSIQ preprogram (n = 26), postprogram (n = 19); WEB-Q preprogram (n = 30), postprogram (n = 10). Improved knowledge (6.0 ± 1.5 vs. 6.9 ± 1.5, P = .05) and intention scores (9.6 ± 4.4 vs. 11.3 ± 4.1, P = .01) were observed. CONCLUSIONS AND IMPLICATIONS A comprehensive school nutrition program can improve knowledge and intentions for intake of MMA in First Nations youth. Environmental constraints beyond the school environment need to be addressed.
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Affiliation(s)
- Michelle Gates
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada.
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Gates M, Hanning RM, Gates A, McCarthy DD, Tsuji LJS. Assessing the impact of pilot school snack programs on milk and alternatives intake in 2 remote First Nation communities in northern Ontario, Canada. THE JOURNAL OF SCHOOL HEALTH 2013; 83:69-76. [PMID: 23331265 DOI: 10.1111/josh.12000] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 05/13/2011] [Accepted: 05/16/2011] [Indexed: 06/01/2023]
Abstract
BACKGROUND Canadian Aboriginal youth have poorer diet quality and higher rates of overweight and obesity than the general population. This research aimed to assess the impact of simple food provision programs on the intakes of milk and alternatives among youth in Kashechewan and Attawapiskat First Nations (FNs), Ontario, Canada. METHODS A pilot school snack program was initiated in Kashechewan in May 2009 including coordinator training and grant writing support. A supplementary milk and alternatives program was initiated in Attawapiskat in February 2010. Changes in dietary intake were assessed using Web-based 24-hour dietary recalls in grade 6 to 8 students, pre- and 1-week post-program, with a 1-year follow-up in Kashechewan. Student impressions were collected after 1 week using open-ended questions in the Web survey. Teacher and administrator impressions were collected via focus groups after 1 year in Kashechewan. RESULTS After 1 week, calcium intake increased in Kashechewan (805.9 ± 552.0 to 1027.6 ± 603.7 mg, p = .044); however, improvements were not sustained at 1 year; milk and alternatives (1.7 ± 1.7 servings to 2.1 ± 1.4 servings, p = .034) and vitamin D (2.5 ± 2.6 to 3.5 ± 3.4 µg, p = .022) intakes increased in Attawapiskat. Impressions of the programs were positive, though limited resources, staff, facilities, and funding were barriers to sustaining the consistent snack provision of the 1-week pilot phase. CONCLUSION These illustrations show the potential of snack programs to address the low intakes of milk and alternatives among youth in remote FNs. Community-level constraints must be addressed for sustained program benefits.
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Affiliation(s)
- Michelle Gates
- University of Waterloo, School of Public Health and Health Systems, 200 University Ave. West, Waterloo, Ontario N2L 3G1, Canada.
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Ganann R, Fitzpatrick-Lewis D, Ciliska D, Peirson L. Community-based interventions for enhancing access to or consumption of fruit and vegetables among five to 18-year olds: a scoping review. BMC Public Health 2012; 12:711. [PMID: 22931474 PMCID: PMC3505745 DOI: 10.1186/1471-2458-12-711] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 08/23/2012] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Rebecca Ganann
- Effective Public Health Practice Project, McMaster University, Hamilton, ON, Canada
| | | | - Donna Ciliska
- Effective Public Health Practice Project, McMaster University, Hamilton, ON, Canada
| | - Leslea Peirson
- Effective Public Health Practice Project, McMaster University, Hamilton, ON, Canada
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Behavior theory for dietary interventions for cancer prevention: a systematic review of utilization and effectiveness in creating behavior change. Cancer Causes Control 2012; 24:409-20. [DOI: 10.1007/s10552-012-9995-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
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Swan E, Bouwman L, de Roos N, Koelen M. How science thinks and practice acts: bridging the gap in weight management interventions for adolescents. Fam Pract 2012; 29 Suppl 1:i117-i125. [PMID: 22399540 DOI: 10.1093/fampra/cmr086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Adolescent obesity calls for evidence-based treatment approaches given its long-term physical and psychosocial consequences. However, research shows there are many problems in the translation of scientific evidence into practice. OBJECTIVE The aim of this study was to develop science- and practice-based recommendations for the planning of future adolescent weight management interventions. METHODS We performed (i) literature reviews on intervention studies targeting treatment of obesity in adolescents and Dutch clinical guidelines for obesity as well as practice-based documents and grey literature on treating obesity and delivering health programs for adolescents and (ii) semi-structured interviews with eight clinicians and four non-clinicians working in obesity treatment, management and prevention to explore perspectives on treating adolescent obesity and using evidence in practice. RESULTS After merging the results from the literature reviews and interviews, four issues emerged: (i) little reporting on theoretical models used in intervention studies, Dutch clinical guidelines and semi-structured interviews; (ii) inconsistency on age-specific considerations for treating obesity in adolescents in intervention studies and Dutch clinical guidelines; (iii) inconsistency on addressing the social nature of obesity in intervention studies and Dutch clinical guidelines and (iv) how professional responsibility should be divided is unclear from intervention studies, Dutch clinical guidelines and semi-structured interviews. CONCLUSIONS Joined action of science and practice is required for future interventions. Future interventions should include topics relevant to the stage of adolescence and give greater focus to the complex social nature of obesity. Lastly, practitioners can generate more practice-based evidence by starting their own practice-based research.
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Affiliation(s)
- Emily Swan
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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McCaughtry N, Martin JJ, Fahlman M, Shen B. Urban health educators' perspectives and practices regarding school nutrition education policies. HEALTH EDUCATION RESEARCH 2012; 27:69-80. [PMID: 22072137 DOI: 10.1093/her/cyr101] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although nutrition-related health education policies exist at national, state and local levels, the degree to which those policies affect the everyday practices of health education teachers who are charged with executing them in schools is often unclear. The purpose of this study was to examine the nutrition-related health education policy matrix that affected one urban school district, the health education teachers' awareness of those policies, the impact of nutrition policies on teachers' instruction and challenges teachers perceived in executing comprehensive nutrition education. The study used interpretive ethnography to examine the educational contexts and perspectives of 27 health educators from 24 middle schools in one urban district in the Midwestern United States. Data were collected through school observations, interviews with key personnel and document collection. We found that a network of nutrition-related education policies governed health education teachers' instruction, but that teachers were uniformly unaware of those policies. Without institutional coherence and clear directives, health education teachers taught little nutrition content, primarily due to poor training, professional development, instructional resources and administrative accountability. The results are discussed in light of the enormous challenges in many urban schools and the need for nutrition education professional development.
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Affiliation(s)
- Nate McCaughtry
- Center for School Health, College of Education, Wayne State University, 125 Matthaei Building, 5101 Lodge Service Dr., Detroit, MI 48202, USA.
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Hoffman JA, Thompson DR, Franko DL, Power TJ, Leff SS, Stallings VA. Decaying behavioral effects in a randomized, multi-year fruit and vegetable intake intervention. Prev Med 2011; 52:370-5. [PMID: 21371499 PMCID: PMC3078952 DOI: 10.1016/j.ypmed.2011.02.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 02/15/2011] [Accepted: 02/21/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the effects of a multi-component, theory-based, 2.5-year intervention on children's fruit and vegetable consumption, preferences, knowledge and body mass index. METHODS Four inner city elementary schools in the Northeastern United States were randomized to an intervention (n=149) or control group (n=148) in 2005. Fruit and vegetable consumption during school lunch (measured by plate waste), preferences, and knowledge, as well as body mass index, were assessed five times across 3.5 years (pre-intervention, spring 2006, 2007, 2008 and 2009). Hierarchical linear modeling was used to analyze program outcomes. RESULTS At the first post-test assessment, children in the experimental group ate 0.28 more servings/lunch of fruit and vegetable relative to children in the control group and changes in fruit and vegetable consumption were found in each year throughout the program. However, this effect declined steadily across time so that by the delayed one-year follow-up period there was no difference between the groups in fruit and vegetable consumption. There were persistent intervention effects on children's knowledge. There were no effects on fruit and vegetable preferences and body mass index throughout the study. CONCLUSION Although there was initial fruit and vegetable behavior change, annual measurements indicated a gradual decay of behavioral effects. These data have implications for the design of school-based fruit and vegetable interventions.
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Godin G, Amireault S, Bélanger-Gravel A, Vohl MC, Pérusse L, Guillaumie L. Prediction of daily fruit and vegetable consumption among overweight and obese individuals. Appetite 2010; 54:480-4. [DOI: 10.1016/j.appet.2010.01.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 01/06/2010] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
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Kazbare L, van Trijp HC, Eskildsen JK. A-priori and post-hoc segmentation in the design of healthy eating campaigns. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/13527260903342712] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jaeger SR, Bava CM. Fruit consumption among people living in a high deprivation New Zealand neighbourhood. Aust N Z J Public Health 2009; 33:471-6. [DOI: 10.1111/j.1753-6405.2009.00432.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kitscha CE, Brunet K, Farmer A, Mager DR. Reasons for non-return to a pediatric weight management program. CAN J DIET PRACT RES 2009; 70:89-94. [PMID: 19515272 DOI: 10.3148/70.2.2009.89] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE Obesity in childhood has become a major public health concern because of increasing rates of overweight and obesity. To address this epidemic, effective dietetic interventions must be developed. We examined parent/caregiver and/or patient reasons for not returning for follow-up clinical care in the Alberta Health Services, Edmonton Area's Nutrition Services Pediatric Weight Management Program (NS PWMP) in Edmonton, Alberta. METHODS A qualitative telephone survey was developed to identify reasons for non-return to the NS PWMP. Face validity was evaluated by five pediatric registered dietitians (RDs). RESULTS The survey was administered to parents/caregivers of children or adolescents aged 2.5 to 14.2 years (n=21) who attended fewer than two appointments in the NS PWMP. The major reasons for non-return included physical barriers (scheduling, parking, location), organizational barriers (clinic environment), and program educational content (type of educational tools, the focus of lifestyle education on the individual rather than the family, physical activity interventions, and appropriateness of information for the parent or child). CONCLUSIONS Development and delivery of effective dietetic interventions for children and adolescents at risk of overweight and obesity may be achieved by emphasizing skill building within the child and the family. Analysis of child and family feedback on clinical RD services is critical to optimization of care in a pediatric weight management program.
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Affiliation(s)
- Catherine E Kitscha
- Nutrition Services, Regional Nutrition and Food Services, Alberta Health Services, Edmonton Area, AB, Canada
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Madlensky L, Natarajan L, Flatt SW, Faerber S, Newman VA, Pierce JP. Timing of dietary change in response to a telephone counseling intervention: evidence from the WHEL study. Health Psychol 2009; 27:539-47. [PMID: 18823180 DOI: 10.1037/0278-6133.27.5.539] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Little is known about temporal patterns of diet change within interventions, nor about predictors of early and sustained successful change. Social-cognitive theory asserts that early successes in achieving behavior change increase self-efficacy, leading to longer-term success. DESIGN The authors conducted exploratory cluster analyses using dietary data from the first month of the telephone counseling intervention of the Women's Healthy Eating and Living (WHEL) Study. MAIN OUTCOME MEASURE Change in dietary pattern at three early intervention timepoints. RESULTS Three clusters were identified: Cluster 1 (25%) was close to meeting study goals at baseline, but still made major changes; Cluster 2 (49%) and Cluster 3 (26%) were not achieving study goals at baseline, but Cluster 2 made substantial immediate changes, while Cluster 3 changed their diet more gradually. Baseline demographic and behavioral variables were associated with cluster membership; however, the strongest predictors of cluster were self-efficacy, motivation, and approaches to study goals. Cluster membership predicted dietary pattern at 12 months. CONCLUSION These data suggest that a one-on-one telephone counseling intervention that is intensive in the early weeks may maximize the level of change achieved in a study.
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Affiliation(s)
- Lisa Madlensky
- Department of Family and Preventive Medicine, University of California, California, USA
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Dixon HG, Scully ML, Wakefield MA, White VM, Crawford DA. The effects of television advertisements for junk food versus nutritious food on children's food attitudes and preferences. Soc Sci Med 2007; 65:1311-23. [PMID: 17587474 DOI: 10.1016/j.socscimed.2007.05.011] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Indexed: 11/19/2022]
Abstract
Television (TV) food advertising has attracted criticism for its potential role in promoting unhealthy dietary practices among children. Content analyses indicate junk food advertising is prevalent on Australian children's TV; healthy eating is rarely promoted. This paper presents (a) a cross-sectional survey examining associations between children's regular TV viewing habits and their food-related attitudes and behaviour; and (b) an experiment assessing the impact of varying combinations of TV advertisements (ads) for unhealthy and healthy foods on children's dietary knowledge, attitudes and intentions. The experimental conditions simulated possible models for regulating food ads on children's TV. Participants were 919 grade five and six students from schools in Melbourne, Australia. The survey showed that heavier TV use and more frequent commercial TV viewing were independently associated with more positive attitudes toward junk food; heavier TV use was also independently associated with higher reported junk food consumption. The experiment found that ads for nutritious foods promote selected positive attitudes and beliefs concerning these foods. Findings are discussed in light of methodological issues in media effects research and their implications for policy and practice. It is concluded that changing the food advertising environment on children's TV to one where nutritious foods are promoted and junk foods are relatively unrepresented would help to normalize and reinforce healthy eating.
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Affiliation(s)
- Helen G Dixon
- Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Australia.
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