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Beresford SA, Rillamas-Sun E, Rudd K, Bishop SK, Deschenie D, Ornelas IJ, Bauer MC, Lombard KA. Development of an assessment tool to measure healthy eating in Navajo children and their families. Curr Dev Nutr 2023; 7:100074. [DOI: 10.1016/j.cdnut.2023.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
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Nathan N, Murawski B, Hope K, Young S, Sutherland R, Hodder R, Booth D, Toomey E, Yoong SL, Reilly K, Tzelepis F, Taylor N, Wolfenden L. The Efficacy of Workplace Interventions on Improving the Dietary, Physical Activity and Sleep Behaviours of School and Childcare Staff: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144998. [PMID: 32664554 PMCID: PMC7400238 DOI: 10.3390/ijerph17144998] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 01/07/2023]
Abstract
There is a need for effective interventions that improve the health and wellbeing of school and childcare staff. This review examined the efficacy of workplace interventions to improve the dietary, physical activity and/or sleep behaviours of school and childcare staff. A secondary aim of the review was to assess changes in staff physical/mental health, productivity, and students’ health behaviours. Nine databases were searched for controlled trials including randomised and non-randomised controlled trials and quasi-experimental trials published in English up to October 2019. PRISMA guidelines informed screening and study selection procedures. Data were not suitable for quantitative pooling. Of 12,396 records screened, seven articles (based on six studies) were included. Most studies used multi-component interventions including educational resources, work-based wellness committees and planned group practice (e.g., walking groups). Multiple outcomes were assessed, findings were mixed and on average, there was moderate risk of bias. Between-group differences in dietary and physical activity behaviours (i.e., fruit/vegetable intake, leisure-time physical activity) favoured intervention groups, but were statistically non-significant for most outcomes. Some of the studies also showed differences favouring controls (i.e., nutrient intake, fatty food consumption). Additional robust studies testing the efficacy of workplace interventions to improve the health of educational staff are needed.
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Affiliation(s)
- Nicole Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
- Correspondence:
| | - Beatrice Murawski
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Kirsty Hope
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Sarah Young
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Rebecca Hodder
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Debbie Booth
- University Library, Academic Division, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia;
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, University Road, Galway H91 TK33, Ireland;
| | - Sze Lin Yoong
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Kathryn Reilly
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Flora Tzelepis
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council New South Wales, 153 Dowling St, Woolloomooloo, NSW 2011, Australia;
- School of Health Sciences, University of Sydney, Camperdown, NSW 2006, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
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Aziz KU, Dennis B, Davis CE, Sun K, Burke G, Manolio T, Faruqui AMA, Chagani H, Ashraf T, Patel N, Jafery H, Ghauri S, Faisal M, Tareen AK. Efficacy of CVD Risk Factor Modification in a Lower-Middle Class Community in Pakistan: The Metroville Health Study. Asia Pac J Public Health 2016; 15:30-6. [PMID: 14620495 DOI: 10.1177/101053950301500106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Metroville Health Study aimed to reduce consumption of total cooking fats by 33%, salt by 25% and replace ghee with vegetable oil in a lower middle class urban community in Pakistan. Households (n=403) were randomly assigned to Intervention and Control groups. A baseline screening collected data on CVD risk factors, knowledge and attitudes and household consumption of cooking fats and salt. Intervention households received information about CVD and regular visits by social workers who measured cooking fats and salt and counselled cooks on the goals of intervention. Two years later, 291 households were re-screened. Intervention households reduced consumption of fats and salt compared to differences were total fat, 48% ( p<0.0001); ghee, 37% ( p=0.005); vegetable oil, 33% ( p=0.0001); and salt, 41% ( p=0.011). Household visits by trained social workers were effective in achieving reductions in consumption of cooking fat and salt in a lower class urban community. Asia Pac J Public Health 2003; 15(1): 30-36.
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Affiliation(s)
- K U Aziz
- Department of Cardiology, N.I.C.V.D., Karachi, Pakistan.
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Bull SS, Gillette C, Glasgow RE, Estabrooks P. Work Site Health Promotion Research: To what Extent can we Generalize the Results and what is Needed to Translate Research to Practice? HEALTH EDUCATION & BEHAVIOR 2016; 30:537-49. [PMID: 14582596 DOI: 10.1177/1090198103254340] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Information on external validity of work site health promotion research is essential to translate research findings to practice. The authors provide a literature review of work site health behavior interventions. Using the RE-AIM framework, they summarize characteristics and results of these studies to document reporting of intervention reach, adoption, implementation, and maintenance. The authors reviewed a total of 24 publications from 11 leading health behavior journals. They found that participation rates among eligible employees were reported in 87.5% of studies; only 25% of studies reported on intervention adoption. Data on characteristics of participants versus nonparticipants were reported in fewer than 10% of studies. Implementation data were reported in 12.5% of the studies. Only 8% of studies reported any type of maintenance data. Stronger emphasis is needed on representativeness of employees, work site settings studied, and longer term results. Examples of how this can be done are provided.
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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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Kushida O, Murayama N. Effects of environmental intervention in workplace cafeterias on vegetable consumption by male workers. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:350-358. [PMID: 24974354 DOI: 10.1016/j.jneb.2014.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/20/2014] [Accepted: 05/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess the effects of an environmental intervention based on the transtheoretical model to increase access to nutritional information about vegetable consumption in workplace cafeterias. DESIGN Nonrandomized controlled trial. SETTING Sixteen workplaces with cafeterias in Niigata, Japan, were assigned to intervention (n = 8) or comparison sites (n = 8). PARTICIPANTS A total of 349 Japanese male workers aged 20-59 years, who visited the cafeterias ≥ 3 times/wk. INTERVENTION For the intervention group, 12 types of table tents containing information on increasing vegetable consumption, based on the transtheoretical model stages and processes of change, were distributed to cafeterias for 24 weeks in 2009. Information was presented according to the sequence suggested by the stages of change. MAIN OUTCOME MEASURES Vegetable consumption in the cafeteria and per day and stage of change were assessed using self-administered questionnaires. ANALYSIS Differences between groups were tested using a generalized linear model adjusted for age, work environment, and position. RESULTS The difference in the stage of change was not statistically significantly different (P = .05), but the intervention group (n = 181) had increased vegetable consumption in the cafeteria (+0.18 servings; P = .01) and per day (+0.32 servings; P = .01) vs the comparison group. CONCLUSIONS AND IMPLICATIONS The findings suggest a beneficial effect of providing access to nutrition information about vegetable consumption as an environmental intervention in workplace cafeterias.
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Affiliation(s)
- Osamu Kushida
- Department of Health and Nutrition, Niigata University of Health and Welfare, Niigata, Japan.
| | - Nobuko Murayama
- Department of Health and Nutrition, Niigata University of Health and Welfare, Niigata, Japan; Department of Health and Nutrition, University of Niigata Prefecture, Niigata, Japan
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Ribeiro RQC, Alves L. Comparison of two school-based programmes for health behaviour change: the Belo Horizonte Heart Study randomized trial. Public Health Nutr 2014; 17:1195-204. [PMID: 23438441 PMCID: PMC10282417 DOI: 10.1017/s1368980013000189] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 11/09/2012] [Accepted: 01/02/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the efficacy of two school-based programmes to promote students' willingness to engage in lifestyle changes related to eating habits and physical activity behaviours. DESIGN Elementary school-based health promotion intervention, designed as a multicomponent experimental study, based on a behavioural epidemiological model. SETTING Nine intervention and eight comparative public and private elementary schools. SUBJECTS The goal was to determine the impact on the longitudinally assessed outcomes of two programmes that addressed healthy nutrition and active living in a cohort of 2038 children. The evaluations used pre-intervention and follow-up student surveys that were based on the Transtheoretical Model of the stages of behaviour change. RESULTS In the intervention group, there were significant (P < 0·001) differences between the pre- and post-intervention times in the stages of change, with a reduction in the percentage of children at the pre-contemplation and contemplation stages and increased percentages at the preparation, action and maintenance stages, leading to healthier behaviours in fatty food consumption, fruit and vegetable consumption, physical activity and time spent in sedentary activities. The determinants of the behaviour stage were the intervention programme, the type of school and the presence of motivated teachers. The comparison group did not show significant differences between the pre- and post-intervention times for any of the stages of behaviour. CONCLUSIONS The intervention programme encouraged the students to make healthy lifestyle choices related to eating habits and physical activity behaviours.
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Affiliation(s)
- Robespierre QC Ribeiro
- Minas Gerais State Secretariat for Health/Non-communicable Disease, Surveillance Sector, Rua Santa Helena 75, 30.220-240 Belo Horizonte, MG, Brazil
| | - Luciana Alves
- Department of Pediatrics, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Lemon SC, Wang ML, Wedick NM, Estabrook B, Druker S, Schneider KL, Li W, Pbert L. Weight gain prevention in the school worksite setting: results of a multi-level cluster randomized trial. Prev Med 2014; 60:41-7. [PMID: 24345602 PMCID: PMC3933312 DOI: 10.1016/j.ypmed.2013.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/03/2013] [Accepted: 12/07/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the effectiveness, reach and implementation of a weight gain prevention intervention among public school employees. METHOD A multi-level intervention was tested in a cluster randomized trial among 782 employees in 12 central Massachusetts public high schools from 2009 to 2012. The intervention targeted the nutrition and physical activity environment and policies, the social environment and individual knowledge, attitudes and skills. The intervention was compared to a materials only condition. The primary outcome measures were change in weight and body mass index (BMI) at 24-month follow-up. Implementation of physical environment, policy and social environment strategies at the school and interpersonal levels, and intervention participation at the individual level were assessed. RESULTS At 24-month follow-up, there was a net change (difference of the difference) of -3.03 pounds (p=.04) and of -.48 BMI units (p=.05) between intervention and comparison conditions. The majority of intervention strategies were successfully implemented by all intervention schools, although establishing formal policies was challenging. Employee participation in programs targeting the physical and social environment was maintained over time. CONCLUSION This study supports that a multi-level intervention integrated within the organizational culture can be successfully implemented and prevent weight gain in public high school employees.
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Affiliation(s)
- Stephenie C Lemon
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Monica L Wang
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Nicole M Wedick
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Barbara Estabrook
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Susan Druker
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Kristin L Schneider
- Rosalind Franklin University of Medicine and Science, Department of Psychology, 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Wenjun Li
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Lori Pbert
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
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Schee CV, Gard M. Healthy, happy and ready to teach, or why kids can’t learn from fat teachers: the discursive politics of school reform and teacher health. CRITICAL PUBLIC HEALTH 2013. [DOI: 10.1080/09581596.2013.828152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Shepherd J, Dewhirst S, Pickett K, Byrne J, Speller V, Grace M, Almond P, Hartwell D, Roderick P. Factors facilitating and constraining the delivery of effective teacher training to promote health and well-being in schools: a survey of current practice and systematic review. PUBLIC HEALTH RESEARCH 2013. [DOI: 10.3310/phr01020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundSchools are an important setting for health promotion and teachers have an integral role to play in promoting children and young people’s health and well-being. Adequate initial teacher training (ITT) and continuing professional development in health is therefore important.ObjectivesTo conduct a survey of initial teacher training providers in England and a systematic review of effectiveness to assess how health and well-being is covered on courses, and to identify barriers and facilitators to effective training.MethodsMethods included an online questionnaire survey with a sample of 220 ITT course managers in England; interviews with a purposive sample of 19 of the course managers responding to the questionnaire; and a two-stage systematic review comprising a descriptive map of the characteristics of international research studies of health teacher training and a detailed synthesis of a subset of studies specifically on pre-service training. Databases (including MEDLINE, EMBASE, The Campbell Library and PsycINFO) were searched from the period of database inception up to May 2011.ResultsThe overall response rate for the survey was 34%. The majority (89%) of respondents agreed that it was either important or very important to cover health within the ITT curriculum. The most commonly covered topics on courses wereEvery Child Matters(100%), child protection (100%), emotional health (99%) and antibullying (97%). Fewer course managers reported covering healthy eating (63%), sex and relationships (62%), drugs (56%), alcohol (41%) and smoking (34%). Many interviewees expressed a holistic view of education and believed that health was important in the ITT curriculum. However, there was variability in how health was addressed across and within institutions. Trainee teachers' experience of addressing child health on school placement was also variable. Facilitators to covering health included interests and backgrounds of ITT staff; staff health-related professional experience; availability of health expertise from external agencies; supportive government policy frameworks; and interprofessional and interdepartmental working. The main barriers were limited curriculum time; health being perceived to be a lower priority than other aspects of training; health no longer a high government priority in education; and lack of funding. A total of 170 studies met the eligibility criteria for the descriptive map. The majority covered teacher training in relation to sexual and reproductive health, drugs and alcohol or mental and emotional health. A total of 21 publications (20 studies) were prioritised for the synthesis. All were evaluations of health training for pre-service teachers, and just under half were from the UK. Twelve studies reported outcomes (impact of training on teachers, but not pupils), many of which were single cohort before-and-after studies. Sixteen studies reported processes. Following training there were some increases in trainee teachers' factual knowledge of health and a general increase in their confidence to address health issues. In general, training was acceptable and well received by trainees. Evidence suggested that effective training should include practical experience and skills and be personally relevant and take into account individual needs. Barriers to health training identified from the studies included lack of time, balancing breadth and depth, and variation in training provision.ConclusionsAmong those surveyed there appears to be general support for health and well-being in ITT. However, further research on the longer-term impact of ITT around health and well-being is needed, particularly in the early career period. The main limitation of this research was the low response rate (34%) to the survey.Study registrationPROSPERO number CRD42012001977.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- J Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), Faculty of Medicine, University of Southampton, Southampton, UK
| | - S Dewhirst
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - K Pickett
- Southampton Health Technology Assessments Centre (SHTAC), Faculty of Medicine, University of Southampton, Southampton, UK
| | - J Byrne
- Southampton Education School, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - V Speller
- Health Development Consulting Ltd, Waterlooville, UK
| | - M Grace
- Southampton Education School, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - P Almond
- Faculty of Health and Social Care, Anglia Ruskin University, Cambridge, UK
| | - D Hartwell
- Southampton Health Technology Assessments Centre (SHTAC), Faculty of Medicine, University of Southampton, Southampton, UK
| | - P Roderick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Baranowski T, Diep C, Baranowski J. Influences on Children's Dietary Behavior, and Innovative Attempts to Change It. ANNALS OF NUTRITION AND METABOLISM 2013; 62 Suppl 3:38-46. [DOI: 10.1159/000351539] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Yin Z, Gutin B, Johnson MH, Hanes J, Moore JB, Cavnar M, Thornburg J, Moore D, Barbeau P. An Environmental Approach to Obesity Prevention in Children: Medical College of Georgia FitKid Project Year 1 Results. ACTA ACUST UNITED AC 2012; 13:2153-61. [PMID: 16421350 DOI: 10.1038/oby.2005.267] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To test the hypothesis that third grade children (mean age = 8.7, SD = 0.5) who attended an 8-month after-school program would exhibit favorable changes in body composition, cardiovascular fitness, blood pressure, total cholesterol, and high-density lipoprotein-cholesterol compared with children in control condition. RESEARCH METHODS AND PROCEDURES Subjects were 61% African-American, 31% white, and 8% other racial background from 18 public schools. Sixty-eight percent were eligible for free or reduced price lunch. Percentage body fat and bone mineral density were assessed by DXA, cardiovascular fitness by heart rate response to a step test, resting blood pressure with a Dinamap, and non-fasting total cholesterol and high-density lipoprotein-cholesterol by finger stick. Data pre- and post-intervention were available for 447 children. Children in the nine intervention schools who attended at least 40% of the after-school sessions were compared with control subjects. RESULTS Compared with the control subjects and after controlling for race, sex, free/reduced price lunch status, and school-level covariates, youths in the intervention group showed a relative reduction of percentage body fat [-0.76 (95% confidence interval (CI), -1.42, -0.09)], a greater relative gain in bone mineral density [0.008 (95% CI, 0.001, 0.005)], and a greater relative reduction in heart rate response to the step test [-4.4 (95% CI, -8.2, 0.6)]. The other outcome variables showed non-significant trends in favor of the intervention subjects. DISCUSSION These results are promising in light of the potential impact on the emerging childhood obesity epidemic. The Medical College of Georgia FitKid Project has the potential to be institutionalized because it is built on the existing infrastructure in most public schools in the U.S.
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Affiliation(s)
- Zenong Yin
- Department of Pediatrics, Georgia Prevention Institute, Augusta, USA.
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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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Ledoux T, Watson K, Baranowski J, Tepper BJ, Baranowski T. Overeating styles and adiposity among multiethnic youth. Appetite 2010; 56:71-7. [PMID: 21115080 DOI: 10.1016/j.appet.2010.11.145] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 11/05/2010] [Accepted: 11/19/2010] [Indexed: 12/11/2022]
Abstract
Reasons for inconsistent associations between overeating styles and adiposity among youth may include differences in effects by age, gender, or ethnicity; failure to control for social desirability of response; or adiposity measurement limitations. This study examined the relationship between overeating styles and multiple measures of adiposity, after controlling for social desirability and testing for moderation by ethnicity, age, and gender. Data from 304 9-10 year old children and 264 17-18 year old adolescents equally representing African American, Hispanic, and White ethnic groups were extracted from a larger cross-sectional study. Measures included the Dutch Eating Behavior Questionnaire (restrained, external, and emotional overeating subscales), the "Lie Scale" from the Revised Children's Manifest Anxiety Scale, and measured weight, height, waist circumference, and triceps skinfold. BMI z-score and a global adiposity index were calculated. Mixed model linear regression showed restraint was positively and external eating was negatively related to measures of adiposity. African American youth had a stronger inverse association between emotional eating and adiposity than White or Hispanic youth. Relationships were not influenced by social desirability nor moderated by age or gender. Overeating styles are related to adiposity in nearly all youth but the nature of these associations are moderated by ethnicity.
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Affiliation(s)
- Tracey Ledoux
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, USA.
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Hartline-Grafton HL, Rose D, Johnson CC, Rice JC, Webber LS. Are school employees role models of healthful eating? Dietary intake results from the ACTION worksite wellness trial. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2009; 109:1548-56. [PMID: 19699834 PMCID: PMC2799115 DOI: 10.1016/j.jada.2009.06.366] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2008] [Accepted: 03/13/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND Little is known about the dietary intake of school employees, a key target group for improving school nutrition. OBJECTIVE To investigate selected dietary variables and weight status among elementary school personnel. DESIGN Cross-sectional, descriptive study. SUBJECTS/SETTING Elementary school employees (n=373) from 22 schools in a suburban parish (county) of southeastern Louisiana were randomly selected for evaluation at baseline of ACTION, a school-based worksite wellness trial. METHODS Two 24-hour dietary recalls were administered on nonconsecutive days by registered dietitians using the Nutrition Data System for Research. Height and weight were measured by trained examiners and body mass index calculated as kg/m(2). STATISTICAL ANALYSES PERFORMED Descriptive analyses characterized energy, macronutrient, fiber, and MyPyramid food group consumption. Inferential statistics (t tests, analysis of variance, chi(2)) were used to examine differences in intake and compliance with recommendations by demographic and weight status categories. RESULTS Approximately 31% and 40% of the sample were overweight and obese, respectively, with higher obesity rates than state and national estimates. Mean daily energy intake among women was 1,862+/-492 kcal and among men was 2,668+/-796 kcal. Obese employees consumed more energy (+288 kcal, P<0.001) and more energy from fat (P<0.001) than those who were normal weight. Approximately 45% of the sample exceeded dietary fat recommendations. On average, only 9% had fiber intakes at or above their Adequate Intake, which is consistent with the finding that more than 25% of employees did not eat fruit, 58% did not eat dark-green vegetables, and 45% did not eat whole grains on the recalled days. Only 7% of employees met the MyPyramid recommendations for fruits or vegetables, and 14% of the sample met those for milk and dairy foods. CONCLUSIONS These results suggest that greater attention be directed to understanding and improving the diets of school employees given their high rates of overweight and obesity, poor diets, and important role in student health.
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Affiliation(s)
- Heather L. Hartline-Grafton
- Food Research and Action Center, 1875 Connecticut Avenue, NW, Suite 540, Washington, DC 20009, Telephone: 202-986-2200, Fax: 202-986-2525
| | - Donald Rose
- Tulane University School of Public Health and Tropical Medicine, Department of Community Health Sciences, 1440 Canal Street, New Orleans, LA 70112, USA, Telephone: 504-988-5742, Fax: 504-988-3540
| | - Carolyn C. Johnson
- Tulane University School of Public Health and Tropical Medicine, Department of Community Health Sciences, 1440 Canal Street, New Orleans, LA 70112, USA, Telephone: 504-988-4068, Fax: 504-988-3540
| | - Janet C. Rice
- Tulane University School of Public Health and Tropical Medicine, Department of Biostatistics, 1440 Canal Street, New Orleans, LA 70112, USA, Telephone: 504-988-7330, Fax: 504-988-1706
| | - Larry S. Webber
- Tulane University School of Public Health and Tropical Medicine, Department of Biostatistics, 1440 Canal Street, New Orleans, LA 70112, USA, Telephone: 504-988-7322, Fax: 504-988-1706
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Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2008; 41:327-50. [PMID: 18322790 DOI: 10.1007/s10464-008-9165-0] [Citation(s) in RCA: 2138] [Impact Index Per Article: 133.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The first purpose of this review was to assess the impact of implementation on program outcomes, and the second purpose was to identify factors affecting the implementation process. Results from over quantitative 500 studies offered strong empirical support to the conclusion that the level of implementation affects the outcomes obtained in promotion and prevention programs. Findings from 81 additional reports indicate there are at least 23 contextual factors that influence implementation. The implementation process is affected by variables related to communities, providers and innovations, and aspects of the prevention delivery system (i.e., organizational functioning) and the prevention support system (i.e., training and technical assistance). The collection of implementation data is an essential feature of program evaluations, and more information is needed on which and how various factors influence implementation in different community settings.
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Affiliation(s)
- Joseph A Durlak
- Department of Psychology, Loyola University Chicago, 6525 North Sheridan Road, Chicago, IL 60626, USA.
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Sahay TB, Ashbury FD, Roberts M, Rootman I. Effective components for nutrition interventions: a review and application of the literature. Health Promot Pract 2006; 7:418-27. [PMID: 16928989 DOI: 10.1177/1524839905278626] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A review of the nutrition intervention literature was conducted for Cancer Care Ontario (CCO) to develop a provincial nutrition and healthy body weight strategy. Controlled trials that were conducted between 1994 and 2000 in North America, Europe, Australia, and New Zealand were included. Fifteen interventions were included, 10 of which showed significant intervention effect and 5 reporting negative effect. Elements of effective interventions included theoretical basis, family involvement, participatory planning and implementation models, clear messages, and adequate training and ongoing support for intervenors. CCO applied these practices to design a pilot intervention. Stakeholders participated in the intervention design and tested for clear messaging. Consistent with social cognitive theory, the intervention included activities for children and parents and provided environmental supports such as transportation and child care. Training and support for implementers and evaluators was provided by CCO.
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Affiliation(s)
- Tina B Sahay
- Health Promotion Consulting Group in Toronto, Canada.
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Varnell SP, Murray DM, Janega JB, Blitstein JL. Design and analysis of group-randomized trials: a review of recent practices. Am J Public Health 2004; 94:393-9. [PMID: 14998802 PMCID: PMC1448264 DOI: 10.2105/ajph.94.3.393] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2003] [Indexed: 11/04/2022]
Abstract
We reviewed group-randomized trials (GRTs) published in the American Journal of Public Health and Preventive Medicine from 1998 through 2002 and estimated the proportion of GRTs that employ appropriate methods for design and analysis. Of 60 articles, 9 (15.0%) reported evidence of using appropriate methods for sample size estimation. Of 59 articles in the analytic review, 27 (45.8%) reported at least 1 inappropriate analysis and 12 (20.3%) reported only inappropriate analyses. Nineteen (32.2%) reported analyses at an individual or subgroup level, ignoring group, or included group as a fixed effect. Hence increased vigilance is needed to ensure that appropriate methods for GRTs are employed and that results based on inappropriate methods are not published.
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Baranowski T. Why combine diet and physical activity in the same international research society? Int J Behav Nutr Phys Act 2004; 1:2. [PMID: 15171787 PMCID: PMC416564 DOI: 10.1186/1479-5868-1-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Accepted: 02/03/2004] [Indexed: 11/24/2022] Open
Abstract
Research in diet and physical activity in the U.S. started in very different traditions, with behavioral science input being uneven in their development. Investigators and policy makers in Europe have recognized the complementarity of diet and physical activity and incorporated them both under the label Public Health Nutrition. Joining these disciplines internationally offers the opportunity to benefit all, since the problems addressed are human, not specific to any one country. In regard to why combine diet and physical activity, at the biological level, there is reason to believe that diet and physical activity working in concert can remodel physiological structures and processes toward healthful ends. The diet and physical activity behaviors themselves vary in characteristics and are similar in others. The behavioral science components of these two disciplines face similar problems, and can learn from the advances made by the other, in the areas of measurement, correlates and intervention. By working together, knowledge will be enhanced from uncovering complementary and interactive relationships between diet and physical activity, and in relation to disease risks, that may result in designing more effective and efficient interventions and policies. Since the behavioral sciences are at a disadvantage in comparison to the biological sciences in terms of scientific advances and thereby capturing the popular imagination for solutions to health problems, we must redouble our efforts to enhance funding for behavioral research in regard to diet and physical activity and to make the research advances necessary to prevent the medicalizing of essentially social and behavioral problems. Nutrition and physical activity should most effectively do this together.
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Affiliation(s)
- Tom Baranowski
- Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030-2600, USA.
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Baranowski T, Baranowski J, Cullen KW, Marsh T, Islam N, Zakeri I, Honess-Morreale L, deMoor C. Squire's Quest! Dietary outcome evaluation of a multimedia game. Am J Prev Med 2003; 24:52-61. [PMID: 12554024 DOI: 10.1016/s0749-3797(02)00570-6] [Citation(s) in RCA: 214] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Fruit, juice, and vegetable (FJV) consumption among children is low. Innovative programs are needed to enable children to increase FJV intake. Psychoeducational multimedia permits the delivery of interventions as designed and capitalizes on known behavior change principles. DESIGN Elementary school was the unit of recruitment, assignment, and analysis. Twenty-six elementary schools were pair matched on size and percentage of free or reduced-price lunch, and randomly assigned to treatment or control groups. Data were collected just before and just after the program. SETTING/PARTICIPANTS All fourth-grade students in participating elementary schools were invited to participate. Data were collected on 1578 students. MAIN OUTCOME Servings of fruit, 100% juice, and vegetables consumed. INTERVENTION Squire's Quest! is a ten-session, psychoeducational, multimedia game delivered over 5 weeks, with each session lasting about 25 minutes. Based on social cognitive theory, educational activities attempted to increase preferences for FJV through multiple exposures and associating fun with their consumption, increase asking behaviors for FJV at home and while eating out, and increase skills in FJV preparation through making virtual recipes. MEASURES Four days of dietary intake were assessed before and after the intervention. Assessment was made by the Food Intake Recording Software System (FIRSSt), which conducts a multiple pass, 24-hour dietary intake interview directly with the children. RESULTS Children participating in Squire's Quest! increased their FJV consumption by 1.0 servings more than the children not receiving the program. CONCLUSIONS Psychoeducational multimedia games have the potential to substantially change dietary behavior. More research is warranted.
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Affiliation(s)
- Tom Baranowski
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA.
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Linnan LA, Emmons KM, Klar N, Fava JL, LaForge RG, Abrams DB. Challenges to improving the impact of worksite cancer prevention programs: comparing reach, enrollment, and attrition using active versus passive recruitment strategies. Ann Behav Med 2002; 24:157-66. [PMID: 12054321 DOI: 10.1207/s15324796abm2402_13] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The impact of worksite intervention studies is maximized when reach and enrollment are high and attrition is low. Differences in reach, enrollment, and retention were investigated by comparing 2 different employee recruitment methods for a home-based cancer-prevention intervention study. METHODS Twenty-two worksites (N = 10,014 employees) chose either active or passive methods to recruit employees into a home-based intervention study. Reach (e.g., number of employees who gave permission to be called at home), Enrollment (e.g., number of employees who joined the home intervention study), and Attrition (e.g., number who did not complete the 12- and 24-month follow-ups) were determined. Analysis at the cluster level assessed differences between worksites that selected active (n = 12) versus passive (n = 10) recruitment methods on key outcomes of interest. Employees recruited by passive methods had significantly higher reach (74.5% vs. 24.4% for active) but significantly lower enrollment (41% vs. 78%) and retention (54% vs. 70%) rates (all ps < .0001). Passive methods also successfully enrolled a more diverse, high-risk employee sample. Passive (vs. active) recruitment methods hold advantages for increased reach and the ability to retain a more representative employee sample. Implications of these results for the design of future worksite studies that involve multilevel recruitment methods are discussed.
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Affiliation(s)
- Laura A Linnan
- Center for Behavioral & Preventive Medicine, Brown University Medical School, USA.
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Abstract
Changing dietary behaviors to prevent chronic disease has been an important research focus for the last 25 years. Here we present a review of published articles on the results of research to identify methods to change key dietary habits: fat intake, fiber intake, and consumption of fruits and vegetables. We divided the research reviewed into sections, based on the channel through which the intervention activities were delivered. We conclude that the field is making progress in identifying successful dietary change strategies, but that more can be learned. Particularly, we need to transfer some of the knowledge from the individual-based trials to community-level interventions. Also, more research with rigorous methodology must be done to test current and future intervention options.
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Affiliation(s)
- Deborah J Bowen
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, MP 900, Seattle, Washington 98109-1024, USA.
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Ammerman AS, Lindquist CH, Lohr KN, Hersey J. The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Prev Med 2002; 35:25-41. [PMID: 12079438 DOI: 10.1006/pmed.2002.1028] [Citation(s) in RCA: 320] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The evidence suggesting that nutrition, particularly dietary saturated fat and fruit and vegetable intake, is related to chronic disease risk has prompted considerable research on behavioral interventions focusing on dietary change. No clear understanding has emerged, however, of the degree to which these interventions can materially influence dietary change, or the types of intervention that are most effective and for whom. Therefore, the primary objective of the current study was to evaluate the overall effectiveness of behavioral dietary interventions in promoting dietary change related to chronic disease risk reduction. A secondary goal was to explore the relative effectiveness of specific intervention features and among different population subgroups. METHODS We conducted an evidence-based review and secondary analysis of existing literature. Our data sources included reports of randomized controlled trials and other study designs identified from multiple searches of MEDLINE, EMBASE, PsycINFO, CINAHL, AGELINE, and AGRICOLA. We included all studies on humans (including children, adolescents, and adults) published in English since 1975 that had been conducted in North America, Europe, or Australia; that had sample sizes of at least 40 subjects at follow-up; that were not based on controlled diets; and that otherwise met inclusion criteria. Through dual review, we abstracted detailed information on study characteristics, methodology, and outcomes relating to consumption of fruits, vegetables, and fats. RESULTS From 907 unduplicated articles originally identified, we retained 104 articles reporting on 92 independent studies. The studies were similarly successful in reducing intake of total and saturated fat, and increasing fruit and vegetable intake. More than three-quarters of the studies (17 of the 22 reporting results for fruit and vegetable intake) reported significant increases in fruit and vegetable intake, with an average increase of 0.6 servings per day. Similar consistent decreases were seen in intake of saturated fat and total fat (7.3% reduction in the percentage of calories from fat). Interventions appeared to be more successful at positively changing dietary behavior among populations at risk of (or diagnosed with) disease than among general, healthy populations. Two intervention components seemed to be particularly promising in modifying dietary behavior-goal setting and small groups. CONCLUSIONS The majority of the interventions reviewed resulted in meaningful improvements in dietary factors behaviors associated with the prevention of chronic disease, particularly among individuals at elevated disease risk. The lack of similarity across studies in outcome measures, study design, analysis strategy, and intervention technique hampered our ability to draw broad conclusions about the most effective behavioral dietary interventions, but our findings offer insight into intervention components that may hold promise for future research efforts.
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Affiliation(s)
- Alice S Ammerman
- Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7400, USA.
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Contento IR, Randell JS, Basch CE. Review and analysis of evaluation measures used in nutrition education intervention research. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2002; 34:2-25. [PMID: 11917668 DOI: 10.1016/s1499-4046(06)60220-0] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The purpose of this review is to provide a summary of the kinds of evaluation measures used in 265 nutrition education intervention studies conducted between 1980 and 1999 and an analysis of psychometric issues arising from such a review. The data are summarized in terms of tables for interventions with each of six key population groups: preschool children, school-aged children, adults, pregnant women and breast-feeding promotion, older adults, and inservice preparation of professionals and paraprofessionals. Measures evaluating knowledge and skills or behavioral capabilities were most widely used in studies with preschool, school-aged, and inservice populations (50%-85%) and less widely used in studies with the other groups, particularly breast-feeding promotion (5%). Measures of potential psychosocial mediators or correlates of behavior such as outcome expectancies, self-efficacy, or behavioral intention were used in 90% of behaviorally focused studies with school-aged children and in about 20% of studies with adults. Dietary intake measures were used in almost all studies, primarily food recalls, records, and quantitative food frequency questionnaires. Short frequency instruments involving only foods targeted in the intervention such as fruits and vegetables are increasingly being used. Measures of specific observable behaviors are also increasingly being used. Physiologic parameters were used in about 33% of behaviorally focused interventions with school-aged children and adults, 20% with older adults, and 65% with pregnant women and/or their infants. Criterion validity of newly developed intake instruments and content validity of instruments measuring mediating variables were reported in the majority (range 50%-90%) of studies. Reliability and stability of measures of mediating variables were reported in 50% to 75% of studies, with reliability coefficients mostly about .6 to .7. Two major conclusions from this review are that evaluation measures should be appropriate to the purpose, duration, and power of the intervention and that measures should have adequate validity and reliability in relation to both the outcomes and characteristics of the target audience. Major implications are that considerable preliminary work needs to be done before any intervention study to develop and test evaluation instruments so that they are appropriate and have adequate psychometric properties, and cognitive testing of published instruments with each new target audience is essential. We will then be better able to make judgments about the effectiveness of nutrition education.
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Affiliation(s)
- Isobel R Contento
- Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, 525W 120th St, New York, NY 10027, USA.
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Linnan LA, Sorensen G, Colditz G, Klar DN, Emmons KM. Using theory to understand the multiple determinants of low participation in worksite health promotion programs. HEALTH EDUCATION & BEHAVIOR 2001; 28:591-607. [PMID: 11575688 DOI: 10.1177/109019810102800506] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low participation at the employee or worksite level limits the potential public health impact of worksite-based interventions. Ecological models suggest that multiple levels of influence operate to determine participation patterns in worksite health promotion programs. Most investigations into the determinants of low participation study the intrapersonal, interpersonal, and institutional influences on employee participation. Community- and policy-level influences have not received attention, nor has consideration been given to worksite-level participation issues. The purpose of this article is to discuss one macrosocial theoretical perspective--political economy of health--that may guide practitioners and researchers interested in addressing the community- and policy-level determinants of participation in worksite health promotion programs. The authors argue that using theory to investigate the full spectrum of determinants offers a more complete range of intervention and research options for maximizing employee and worksite levels of participation.
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Affiliation(s)
- L A Linnan
- University of North Carolina at Chapel Hill, School of Public Health, 27599, USA.
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Grunbaum JA, Rutman SJ, Sathrum PR. Faculty and staff health promotion: results from the School Health Policies and Programs Study 2000. THE JOURNAL OF SCHOOL HEALTH 2001; 71:335-339. [PMID: 11586876 DOI: 10.1111/j.1746-1561.2001.tb03512.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- J A Grunbaum
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K-33, 4770 Buford Highway, NE, Atlanta, GA 30341, USA.
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Impact of a health promotion program on the health of primary school principals. INTERNATIONAL JOURNAL OF EDUCATIONAL MANAGEMENT 2001. [DOI: 10.1108/09513540110366132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Resnicow K, Odom E, Wang T, Dudley WN, Mitchell D, Vaughan R, Jackson A, Baranowski T. Validation of three food frequency questionnaires and 24-hour recalls with serum carotenoid levels in a sample of African-American adults. Am J Epidemiol 2000; 152:1072-80. [PMID: 11117617 DOI: 10.1093/aje/152.11.1072] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The validity of self-reported fruit and vegetable intake in minority populations has not been adequately established. In this study, the authors examined the association of three food frequency questionnaires (FFQs) and 24-hour dietary recalls with serum carotenoid levels. Approximately 1,000 African-American adults recruited from 15 churches in Atlanta, Georgia (1997-1998) completed three fruit and vegetable FFQs: a seven-item instrument assessing intake during the past month; a two-item measure assessing usual intake; and a 36-item measure adapted from the Health Habits and History Questionnaire. A total of 414 participants received a 24-hour recall by telephone, and 105 of them received two additional recalls. Serum levels of lycopene, lutein, cryptoxanthin, alpha-carotene, and beta-carotene were assessed in 813 participants and used as the validity criterion. The correlations of fruit and vegetable servings with specific and total serum carotenoid levels were generally higher for the 36-item FFQ than for the two-item and seven-item instruments. The strongest correlation of fruit and vegetable servings with total carotenoid levels was observed for the three recalls (r = 0.42), with the 36-item FFQ and the single 24-hour recall yielding comparable correlations (r = 0.35 and r = 0.37, respectively). The validity of the 36-item fruit and vegetable FFQ was generally as strong as the validity of both 1 and 3 days of recalls. Given the lower cost and time needed for administration relative to recalls, it appears that the 36-item FFQ has merit for evaluating fruit and vegetable health interventions.
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Affiliation(s)
- K Resnicow
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Ciliska D, Miles E, O’brien MA, Turl C, Hale Tomasik H, Donovan U, Beyers J. Effectiveness of Community-Based Interventions to Increase Fruit and Vegetable Consumption. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s0022-3182(00)70594-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Baranowski T, Davis M, Resnicow K, Baranowski J, Doyle C, Lin LS, Smith M, Wang DT. Gimme 5 fruit, juice, and vegetables for fun and health: outcome evaluation. HEALTH EDUCATION & BEHAVIOR 2000; 27:96-111. [PMID: 10709795 DOI: 10.1177/109019810002700109] [Citation(s) in RCA: 214] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A theory-based multicomponent intervention (Gimme 5) was designed and implemented to impact fourth- and fifth-grade children's fruit, juice, and vegetable (FJV) consumption and related psychosocial variables. Gimme 5 was a randomized controlled intervention trial with school (n = 16 elementary) as unit of random assignment and analysis. Participants included the cohort of students who were in the third grade in the winter of 1994 and students who joined them in the fourth and fifth grades. The intervention included a curriculum, newsletters, videotapes, and point-of-purchase education. Evaluation included 7-day food records and psychosocial measures from students, telephone interviews with parents, and observational assessments. Favorable results were observed for consumption of FJV combined, FJV consumed at weekday lunch, eating FJV self-efficacy, social norms, asking behaviors, and knowledge. A theory-based school nutrition education program can help change children's FJV consumption and impact factors at home that predispose to FJV consumption, but changes were small, and their persistence is unknown.
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Affiliation(s)
- T Baranowski
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
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Cullen KW, Baranowski T, Baranowski J, Hebert D, deMoor C, Hearn MD, Resnicow K. Influence of school organizational characteristics on the outcomes of a school health promotion program. THE JOURNAL OF SCHOOL HEALTH 1999; 69:376-380. [PMID: 10633323 DOI: 10.1111/j.1746-1561.1999.tb06433.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Researchers assessed the possible moderating effects of school organizational characteristics (school climate, school health, and job satisfaction) on outcomes of a teacher health behavior change program. Thirty-two public schools were matched and randomly assigned either to treatment or control conditions. Organizational, dietary, and physiologic data were collected from third to fifth grade teachers over three years. Treatment schools received a teacher wellness program for two years. Psychometrics of most organizational scales achieved acceptable levels of reliability. Mixed model analyses were conducted to test for moderating effects. Treatment schools with high organizational climate and health scores reported higher fruit and juice and vegetable consumption at Year 2 compared with intervention schools with low scores. Treatment schools with high job satisfaction scores reported higher fruit and juice and lower-fat food consumption at Year 3 compared with intervention schools with low scores. These measures may be used as a tool to assess the environment in which school health promotion programs are presented. Future interventions may need to be tailored to the organizational characteristics of schools.
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Affiliation(s)
- K W Cullen
- Dept. of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
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Baranowski T, Smith M, Thompson WO, Baranowski J, Hebert D, de Moor C. Intraindividual variability and reliability in a 7-day exercise record. Med Sci Sports Exerc 1999; 31:1619-22. [PMID: 10589866 DOI: 10.1097/00005768-199911000-00019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE High levels of day-to-day or intraindividual variability implies unreliability of a measure of physical activity. Unreliability in a measure leads to attenuation of correlations with other variables. As intraindividual variability increases, the number of days necessary to assess physical activity to achieve the desired level of reliability increases. The use of an intraclass correlation to assess day-to-day reliability in a measure assumes compound symmetry. METHODS This study reports on these issues in a sample of 165 elementary school teachers who maintained a 7-d record of physical activity each year for 3 yr. Analyses were conduced with physical activity measured as minutes, MET minutes, and kcal. Analyses were conducted with PROC MIXED in SAS controlling for the clustering effect by school. RESULTS Compound symmetry could not be supported across 7 d of the record. The weekdays tended to intercorrelate, Saturday correlated at very low levels, and Sunday correlated with Monday only. Compound symmetry was supported across the three weeks. CONCLUSIONS To achieve a reliability of 0.8 using a 7-d activity record requires 2 wk of assessment. The reliability of measures of physical activity require more careful attention, and likely require more points of assessment to achieve desired levels.
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Affiliation(s)
- T Baranowski
- Rollins School of Public Health of Emory University, Atlanta, GA, USA. @internet
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Baranowski T, Anderson C, Carmack C. Mediating variable framework in physical activity interventions. How are we doing? How might we do better? Am J Prev Med 1998; 15:266-97. [PMID: 9838973 DOI: 10.1016/s0749-3797(98)00080-4] [Citation(s) in RCA: 587] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Behavioral science provides the foundation for physical activity interventions. The mediating variable framework is used to assess the status of physical activity interventions and the roles that are, or could be played, by behavioral theory. METHODS Twenty-five physical activity intervention studies and 45 physical activity correlational studies were found in the literature, tabulated, and included in the analysis. RESULTS Behavioral interventions for promoting physical activity have worked primarily when participants were motivated enough to volunteer or when a school-based physical education program changed. In most cases, behavioral or psychosocial theory accounted for 30% or less of the variability in physical activity behaviors. Most intervention studies do not measure mediating variables, and when they do, they do not systematically effect changes in all the mediating variables on which they are predicated. DISCUSSION To increase the effectiveness of physical activity interventions, more physical activity research should focus on a better understanding of the predictors of physical activity and toward interventions demonstrated to effect change in these predictors of physical activity. CONCLUSION Changing the focus to basic behavioral and social science and mediator change research should provide a more systematic and cost-effective approach to increasing the effectiveness of physical activity interventions.
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Affiliation(s)
- T Baranowski
- Department of Behavioral Science, University of Texas, M. D. Anderson Cancer Center, Houston 77030-4095, USA
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Allegrante JP. School-site health promotion for faculty and staff: a key component of the coordinated school health program. THE JOURNAL OF SCHOOL HEALTH 1998; 68:190-195. [PMID: 9672857 DOI: 10.1111/j.1746-1561.1998.tb01299.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- J P Allegrante
- Dept. of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA.
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