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Franken SC, Smit CR, de Leeuw RN, van Woudenberg TJ, Burk WJ, Bevelander KE, Buijzen M. Understanding the behavioral determinants of adolescents' water consumption: A cross-country comparative study. DIALOGUES IN HEALTH 2023; 2:100101. [PMID: 38515488 PMCID: PMC10953952 DOI: 10.1016/j.dialog.2023.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 03/23/2024]
Abstract
Substituting the consumption of sugar-sweetened beverages (SSB) with that of water can have a positive effect on adolescents' health. However, despite the attention on this topic in the Global North, it is relatively understudied in other regions of the world, such as the Caribbean. To guide the development of future interventions, understanding the factors determining water consumption among Caribbean adolescents is important. This study examined the behavioral determinants of water consumption among adolescents in Aruba (the Caribbean) and compared them to those in the Netherlands (Western Europe). We used a theoretical model that integrates the dominant theoretical perspectives in the field of public health, including theories of planned behavior, social norms, and intrinsic motivation. This cross-country study included 1,584 adolescents from Aruba and the Netherlands (52% girls; M = 12.34 years; SD = 2.14). The data were analyzed using regression analyses. This study found that in Aruba, adolescents with higher scores of intrinsic motivation, friends' descriptive norms, attitudes, and behavioral control regarding water consumption drank more water. Moreover, the associations between water consumption and both intrinsic motivation as well as friends' descriptive norms for adolescents in Aruba were stronger than those found in the Netherlands. These associations imply that it is even more important for Aruban adolescents than Dutch adolescents to be intrinsically motivated or to perceive their friends often consuming water to drink more water. The cross-country comparison implies that future interventions in Aruba aimed at increasing adolescents' water consumption as an alternative to SSB should focus on enhancing their intrinsic motivation while considering their friends' social norms.
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Affiliation(s)
- Saskia C.M. Franken
- Faculty for Accounting, Finance, and Marketing, University of Aruba, J.E. Irausquinplein 4, Oranjestad, Aruba
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Crystal R. Smit
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Rebecca N.H. de Leeuw
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, the Netherlands
| | - Thabo J. van Woudenberg
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands
| | - William J. Burk
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, the Netherlands
| | - Kirsten E. Bevelander
- Radboud Institute for Health Sciences, Radboud University and Medical Centre, P.O. Box 9102, 6500 HC Nijmegen, the Netherlands
| | - Moniek Buijzen
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, the Netherlands
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Kaur S. Barriers to consumption of fruits and vegetables and strategies to overcome them in low- and middle-income countries: a narrative review. Nutr Res Rev 2023; 36:420-447. [PMID: 36004512 DOI: 10.1017/s0954422422000166] [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] [Indexed: 11/06/2022]
Abstract
This review provides an overview of the barriers to the consumption of fruits and vegetables (FVs) as well as strategies to improve the intake of FVs in low- and middle-income countries (LMICs). The importance of the consumption of FVs and its role in disease prevention are discussed briefly. Trends in the consumption of FVs in LMICs are also summarised. The WHO recommends that every individual should consume at least five servings or 400 grams of FVs per day. Epidemiological and clinical investigations have demonstrated that FVs contain numerous bioactive compounds with health-protecting activities. Despite their health benefits, the intake of FVs in LMICs remains low. Major barriers identified were socio-demographic factors, environmental conditions, individual and cultural factors, and macrosystem influences. These barriers may be lowered at the household, school, community, and national level through multi-component interventions including behaviour change communication (BCC) initiatives, nutrition education (NE), gardening initiatives, farm to institution programs (FIPs), food baskets, cash transfers, nutrition-agriculture policy and program linkages, and food-market environment-based strategies. This review has research implications due to the positive outcomes of strategies that lower such barriers and boost consumption of FVs in LMICs.
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Affiliation(s)
- Sukhdeep Kaur
- Department of Food and Nutrition, Punjab Agricultural University, Ludhiana, Punjab141004, India
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3
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Brown CR, Rocke K, Murphy MM, Hambleton IR. Interventions and policies aimed at improving nutrition in Small Island Developing States: a rapid review. Rev Panam Salud Publica 2022; 46:e33. [PMID: 36042710 PMCID: PMC9409607 DOI: 10.26633/rpsp.2022.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/22/2022] [Indexed: 01/04/2023] Open
Abstract
Objective. To describe features of nutritional interventions implemented in Small Island Developing States (SIDS) in the past 20 years. Methods. A rapid scoping review was conducted by searching PubMed and Web of Science databases for interventions conducted in SIDS that sought to improve the nutrition of their populations between 2000 and 2019 inclusive. The Noncommunicable diseases progress monitor 2020 was also examined to assess nutritional policies in SIDS. Results. A total of 174 interventions were implemented in 49 of the 58 SIDS. The greatest proportion were conducted in the Caribbean (75 interventions; 43%), with the Pacific region, and the Atlantic, Indian Ocean, Mediterranean and South China Sea region each implementing about 30% of interventions. Using the NOURISHING framework, most interventions (67%) were implemented at the community and national or policy level, using multiple components of the framework. The greatest proportion of interventions (35%) were educational and awareness raising. Restrictions on physical availability of and increased taxation on alcohol were the most commonly reported policies that were partially or fully achieved; restrictions on fats were the least commonly reported. These findings were generally consistent across the SIDS regions. Conclusions. There is a paucity of nutritional policies in SIDS; the reasons may be linked to their social, economic, and environmental vulnerabilities. Interventions should be expanded beyond education to encompass multiple components of the NOURISHING framework, with multisectoral inclusion to ensure stronger stakeholder collaboration and buy-in. A systematic review is warranted using a fuller range of sources to assess the effectiveness of interventions.
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Affiliation(s)
- Catherine R. Brown
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Kern Rocke
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Madhuvanti M. Murphy
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Ian R. Hambleton
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
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Smit CR, Bevelander KE, de Leeuw RNH, Buijzen M. Motivating Social Influencers to Engage in Health Behavior Interventions. Front Psychol 2022; 13:885688. [PMID: 35936257 PMCID: PMC9354713 DOI: 10.3389/fpsyg.2022.885688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Social influencers are widely known as the promotors of purchase behavior as well as for their potential to change health behaviors among individuals in their social networks. For social influencers to be successful in changing behaviors, it is essential that they convey their message in an authentic, original, credible, and persistent manner. In the context of health behavior interventions, this requires a focus on the motivation of social influencers to engage in the intervention. This perspective article describes the importance of motivating social influencers to engage in the desired health behaviors themselves and to promote it within their social network. We briefly describe the current state of knowledge and our empirical experience in implementing health interventions with social influencers. Using insights from self-determination theory, we demonstrate how social influencers can be motivated optimally in health behavior interventions and, thereby, improving the success of the intervention. To illustrate these insights and guide intervention practice, we provide concrete examples of techniques that can be applied in health interventions involving social influencers. We conclude with directions for further research and intervention practice to improve the delivery of health behavior interventions.
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Affiliation(s)
- Crystal R. Smit
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
- *Correspondence: Crystal R. Smit
| | - Kirsten E. Bevelander
- Radboud Institute for Health Sciences, Radboud University and Medical Centre, Nijmegen, Netherlands
| | | | - Moniek Buijzen
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
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Oladele CR, Colón-Ramos U, Galusha D, Tran E, Adams OP, Maharaj RG, Nazario CM, Nunez M, Pérez-Escamilla R, Nunez-Smith M. Perceptions of the local food environment and fruit and vegetable intake in the Eastern Caribbean Health Outcomes research Network (ECHORN) Cohort study. Prev Med Rep 2022; 26:101694. [PMID: 35242499 PMCID: PMC8861285 DOI: 10.1016/j.pmedr.2022.101694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 12/26/2021] [Accepted: 01/15/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Studies conducted in the US and other high-income countries show that the local food environment influences dietary intakes that are protective for cardiovascular health.However, few studies have examined this relationship in the Caribbean. This study aimed to determine whether perceptions of the local food environment were associated with fruit and vegetable (FV) intake in the Eastern Caribbean, where daily FV intake remains below recommended levels. METHODS Cross-sectional analysis of Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS) baseline data (2013-2016) from Barbados, Puerto Rico, Trinidad and Tobago, and US Virgin Islands was conducted in 2020. The National Cancer Institute Dietary Screener Questionnaire was adapted to measure daily servings of FV. Existing scales were used to assess participant perceptions of the food environment (availability, affordability, and quality). Chi-square tests and Poisson regression were used for analyses. RESULTS Participants reported eating one mean daily serving of FV. Mean daily intake was higher among those who perceived FV as usually/always affordable, available, and high quality. Multivariate results showed statistically significant associations between FV and affordability. Persons who perceived FV as affordable had 0.10 more daily servings of FV compared to those who reported FV as not always affordable (p = 0.02). Food insecurity modified the association between affordability and FV intake. CONCLUSIONS This study highlights the importance of affordability in consumption of FV in the Eastern Caribbean, and how this relationship may be modified by food insecurity.
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Affiliation(s)
- Carol R Oladele
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT 06510, USA
| | - Uriyoán Colón-Ramos
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC 20052, USA
| | - Deron Galusha
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT 06510, USA
| | - Emma Tran
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT 06510, USA
| | - Oswald P Adams
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Rohan G Maharaj
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Cruz M Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Maxine Nunez
- University of the Virgin Islands, School of Nursing, St. Thomas, US VI, USA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College Street, Suite 216, New Haven, CT 06520, USA
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT 06510, USA
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Quelly SB, Eckhoff DO, Luzincourt G, Garcia J, Smith S. Feasibility of parents promoting fruit-infused water to reduce preschool children's sugar-sweetened beverage consumption. Nutr Health 2022; 28:291-296. [PMID: 35289221 DOI: 10.1177/02601060221086113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Increasing water and decreasing sugar-sweetened beverage (SSB) consumption in preschoolers provide a strategy to reduce lifelong obesity risks. Aim: To determine feasibility/acceptability and examine preliminary findings of an innovative intervention for preschooler parents to promote fruit-infused water (FIW) to decrease SSB intake. Methods: Fourteen parents of preschoolers completed a pre-intervention survey, attended a presentation with a FIW demonstration/taste-testing, received pitchers/strainers, cutting boards, and FIW recipes/instructions, and received 8 supportive text messages over one month. Feasibility/acceptability was determined from analyzing parents' responses about participating. Descriptive statistics were conducted to analyze pre-/post-intervention survey data. Results: Three themes emerged: "Healthy Option Alternative"; "Feasible to Make FIW at Home"; and "Benefits for Parents". Preliminary findings from ten parents completing both pre-/post-intervention surveys indicated a decrease in preschoolers' total SSB amount/kcal intake, and an increase in parent self-efficacy and FIW knowledge/consumption. Conclusion: Preliminary findings provide valuable feasibility/acceptability information to guide a larger future study.
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Affiliation(s)
- Susan B Quelly
- Associate Professor and Director of the MSN Nurse Educator Program in the College of Nursing at the 6243University of Central Florida in Orlando, FL, U.S.A
| | - Dawn O Eckhoff
- Assistant Professor in the College of Nursing at the 6243University of Central Florida in Orlando, FL, U.S A
| | - Geraldine Luzincourt
- Associate Instructor in the College of Nursing at the 6243University of Central Florida in Orlando, FL, U.S.A
| | - Jeanette Garcia
- Assistant Professor in the Department of Health Sciences in the College of Health Professions and Sciences at the 6243University of Central Florida in Orlando, FL, U.S.A
| | - Sharlene Smith
- Assistant Professor and Director in the College of Nursing at the University of South Florida in Tampa, FL, U.S.A.,PhD student in the College of Nursing at the 6243University of Central Florida, Orlando, FL, U.S.A
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Grummon AH, Sokol RL, Goodman D, Hecht CA, Salvia M, Musicus AA, Patel AI. Storybooks About Healthy Beverage Consumption: Effects in an Online Randomized Experiment With Parents. Am J Prev Med 2022; 62:183-192. [PMID: 34688521 PMCID: PMC8748291 DOI: 10.1016/j.amepre.2021.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/29/2021] [Accepted: 07/28/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Parents spend substantial time reading to their children, making storybooks a promising but understudied avenue for motivating parents to serve their children healthier beverages. This study examines parents' reactions to messages promoting healthy beverage consumption embedded in a children's storybook. METHODS In 2020, a total of 2,164 demographically diverse parents of children aged 6 months to 5 years participated in an online survey. Participants were randomized to view control messages (school readiness) or 1 of 3 beverage message topics (sugary drink discouragement, water encouragement, or combined discouragement and encouragement) presented as pages from the storybook Potter the Otter. Survey items assessed parents' reactions to the messages and their perceptions, beliefs, and intentions regarding sugary drinks and water. Data were analyzed in 2021. RESULTS Compared with control messages, exposure to the beverage messages led to higher discouragement from serving children sugary drinks and higher encouragement to serve children more water (p<0.001). The beverage messages also elicited more thinking about beverages' health impacts and led to stronger perceptions that sugary drinks are unhealthy (p<0.001). Moreover, the beverage messages led to higher intentions to limit serving children sugary drinks and higher intentions to serve children more water (p≤0.02). Parents' reactions to the beverage messages did not differ by most demographic characteristics. Few differences in outcomes were observed among the 3 beverage message topics. CONCLUSIONS Embedding beverage messages in storybooks is a promising, scalable strategy for motivating parents from diverse backgrounds to serve children more water and fewer sugary drinks.
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Affiliation(s)
- Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Rebeccah L Sokol
- School of Social Work, Wayne State University, Detroit, Michigan
| | - Dina Goodman
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christina A Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
| | - Meg Salvia
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anisha I Patel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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Beun RJ, Luiten C, Verbeek C, Poelman MP. A Rationale for a Gamified E-Coach Application to Decrease the Consumption of Sugar Sweetened Beverages. Front Digit Health 2021; 2:564529. [PMID: 34713037 PMCID: PMC8521872 DOI: 10.3389/fdgth.2020.564529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
The design and implementation of applications for behavior change should be preceded by careful analysis of the behavior change process and the target population. We, therefore, present on the basis of a blended research approach a rationale, opportunities and basic requirements for an application that offers a program for reducing intake of sugar sweetened beverages (SSB) by adolescents. This paper discusses the role of e-coaching and gamification as two high-touch design patterns in the behavior change process. Both design patterns aim at supporting the individual in a transformational journey from a current state toward a desired state where the detrimental behavior should be replaced by healthy alternative behavior. First, an elementary behavior scheme is introduced that frames three empirical studies. In the first study (plenary focus groups; n = 13), participants advised to include system recommendations for alternative healthy behavior, stressed the need for personalization of the e-coach and showed strong appreciation for the inclusion of gamification elements. The second study (online survey; n = 249) showed that SSB-intake is highly contextual and that reasons for (limiting) consumption SSB varies greatly between individuals, which the e-coach application should take into account. In a final small-scale pilot study (n = 27), we observed the potential of the inclusion of gamification elements, such as challenges and rewards, to increase compliance to the self-monitoring process of SSB consumption. Building upon these insights and prior studies, we argue that an e-coach mimics the collaborative practice of the program; its main task is to enrich the interaction with cooperative conversational experiences, in particular with respect to the alignment between user and system, motivational encouragement, personalized advice, and feedback about the activities. In addition, we outline that gamification not only has the potential to increase self-monitoring of the target behavior, user engagement, and commitment with the intervention program, but also enables a designer to shift long-term negative outcome of excessive intake in real life to short-term consequences in a virtual environment. In future larger follow-up studies, we advise to integrate the two design patterns within a social network of virtual and human agents that play a variety of competitive, normative and supportive roles.
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Affiliation(s)
- Robbert Jan Beun
- Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
| | - Claire Luiten
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, Netherlands
| | - Chris Verbeek
- Faculty of Science, Informatics Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
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St. Pierre C, Guan W, Barry L, Dease G, Gottlieb S, Morris A, Merrill J, Sacheck JM. Themes in Train-the-Trainer Nutrition Education Interventions Targeting Middle School Students: A Systematic Review. Nutrients 2021; 13:2749. [PMID: 34444910 PMCID: PMC8398099 DOI: 10.3390/nu13082749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022] Open
Abstract
Context-appropriate nutrition education interventions targeting middle school students have the potential to promote healthy dietary patters that may help prevent unnecessary weight gain at a point in childhood development when youth experience increasing agency over their food choices. The aim of this review was to identify and synthesize themes in train-the-trainer approaches, intervention content and delivery, and youth receptivity across teacher, mentor, and peer-led nutrition education interventions that targeted middle school-age youth in urban, primarily low-income settings. A systematic, electronic literature search was conducted in seven electronic databases, PubMed/Medline, CINAHL, ERIC, PsycINFO, Scopus, SPORTDiscus, and Cochrane CENTRAL, using fixed inclusion and exclusion criteria. A total of 53 papers representing 39 unique interventions were selected for data extraction and quality assessment. A framework synthesis approach was used to organize the interventions into six categories and identify themes according to whether the intervention was classroom-based or out-of-school-based and whether adults, cross-age peers or same-age peers delivered the intervention. Ten of the interventions contained multiple components such that they were included in two of the categories. The review findings indicated that trainings should be interactive, include opportunities to role-play intervention scenarios and provide follow-up support throughout intervention delivery. Interventions targeting middle school youth should include positive messaging and empower youth to make healthy choices within their specific food environment context.
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Affiliation(s)
- Christine St. Pierre
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (G.D.); (J.M.S.)
| | - Win Guan
- Up2Us Sports, New York, NY 10018, USA; (W.G.); (J.M.)
| | - Leah Barry
- Department of Sociology, Tulane University, New Orleans, LA 70118, USA; (L.B.); (S.G.)
| | - Grace Dease
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (G.D.); (J.M.S.)
| | - Sydney Gottlieb
- Department of Sociology, Tulane University, New Orleans, LA 70118, USA; (L.B.); (S.G.)
| | - Arielle Morris
- School of Science & Engineering, Tulane University, New Orleans, LA 70118, USA;
| | | | - Jennifer M. Sacheck
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (G.D.); (J.M.S.)
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10
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Rodger A, Wehbe LH, Papies EK. "I know it's just pouring it from the tap, but it's not easy": Motivational processes that underlie water drinking. Appetite 2021; 164:105249. [PMID: 33887422 DOI: 10.1016/j.appet.2021.105249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
Water drinking behaviour is under-researched despite the prevalence and adverse health consequences of underhydration. We conducted a qualitative exploration into the motivational processes underlying water drinking, informed by a grounded cognition perspective on desire and motivated behaviour. We interviewed and analysed data from 60 participants stratified by age, gender, and education level using thematic analysis, to generate three key themes. "Water as situated habits," suggests that participants form and maintain situated water drinking habits, so that within certain situations they regularly drink water. However, participants who situated their water intake only in one key situation (e.g., work routine), had low and inconsistent intake when they left this situation. Some situations happened so infrequently during the day (e.g., before bed) that participants' daily water intake was low. Many participants reported drinking water in reaction to thirst cues, but these were easily suppressed or ignored, so that water drinking was inconsistent. Participants who saw drinking water as part of their self-identity had consistent and high water intake across a variety of situations. "Knowledge and attitudes," suggests that few participants had knowledge or attitudes that promoted water intake (e.g., perceived water as positive or understood the importance of hydration). "Strategies underlying attempts to increase intake" suggests that many participants lacked insight into strategies to increase water intake, although they spontaneously discussed attempts to drink more. This lead to ineffective attempts at behaviour change. Participants' mentions of dehydration and their responses to a urine colour chart suggested that many participants were possibly underhydrated. Our findings suggest that interventions and practitioners attempting to increase water intake need to increase knowledge about the importance of hydration, and encourage individuals to develop effective situated water drinking habits.
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Affiliation(s)
- Amy Rodger
- School of Psychology, Institute of Neuroscience and Psychology, University of Glasgow, UK.
| | - Lara H Wehbe
- School of Psychology, Institute of Neuroscience and Psychology, University of Glasgow, UK
| | - Esther K Papies
- School of Psychology, Institute of Neuroscience and Psychology, University of Glasgow, UK
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11
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Smit CR, de Leeuw RNH, Bevelander KE, Burk WJ, van Woudenberg TJ, Buijs L, Buijzen M. Promoting water consumption among Dutch children: an evaluation of the social network intervention Share H 2O. BMC Public Health 2021; 21:202. [PMID: 33482776 PMCID: PMC7825228 DOI: 10.1186/s12889-021-10161-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background There is a need to develop and improve interventions promoting healthy drinking behaviors among children. A promising method could be to stimulate peer influence within children’s social networks. In the Share H2O social network intervention (SNI), peer influence was utilized by selecting a subset of influential children and training them as ‘influence agents’ to promote water consumption—as an alternative to SSBs. Previous research has mainly focused on the process of selecting influence agents. However, the process of motivating influence agents to promote the behavior has hardly received any research attention. Therefore, in the SNI Share H2O SNI, this motivation process was emphasized and grounded in the self-determination theory (SDT). This study evaluated the implementation of the Share H2O SNI, focusing on whether and how applying SDT-based techniques can motivate the influence agents and, indirectly, their peers. Methods This study included data collected in the Netherlands from both the influence agents (n = 37) and the peers (n = 112) in the classroom networks of the influence agents. Self-reported measurements assessed the influence agents’ enjoyment of the training, duration and perceived autonomy support during the training, and changes in their intrinsic motivation and water consumption before and after the start of the intervention. Changes in the peers’ intrinsic motivation, perceived social support, and social norms were measured before and after the start of the intervention. Results The influence agents enjoyed the training, the duration was adequate, and perceived it as autonomy supportive. There was an increase in the influence agents’ intrinsic motivation to drink water and their actual water consumption. Providing personal meaningful rationales seemed to have motivated the influence agents. The intrinsic motivation and perceived descriptive norm of the peers remained stable. The peers reported an increase in their perceived social support and injunctive norm concerning water drinking after the intervention. Influence agents appeared to mainly use face-to-face strategies, such as modeling, talking to peers, and providing social support to promote the behavior. Conclusions The current findings provided preliminary evidence of the promising effects of using SDT-based techniques in an SNI to motivate the influence agents and, indirectly, their peers. Trial registration NTR, NL6905, Registered 9 January 2018, https://www.trialregister.nl/trial/6905
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Affiliation(s)
- Crystal R Smit
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands. .,Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | | | - Kirsten E Bevelander
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Radboud University and Medical Centre, Nijmegen, The Netherlands
| | - William J Burk
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Thabo J van Woudenberg
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Laura Buijs
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Moniek Buijzen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
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12
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Promoting water consumption among children: a three-arm cluster randomised controlled trial testing a social network intervention. Public Health Nutr 2020; 24:2324-2336. [PMID: 33243308 PMCID: PMC8145454 DOI: 10.1017/s1368980020004802] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: To test the effectiveness of a social network intervention (SNI) to improve children’s healthy drinking behaviours. Design: A three-arm cluster randomised control trial design was used. In the SNI, a subset of children were selected and trained as ‘influence agents’ to promote water consumption–as an alternative to sugar-sweetened beverages (SSB)–among their peers. In the active control condition, all children were simultaneously exposed to the benefits of water consumption. The control condition received no intervention. Setting: Eleven schools in the Netherlands. Participants: Four hundred and fifty-one children (Mage = 10·74, SDage = 0·97; 50·8 % girls). Results: Structural path models showed that children exposed to the SNI consumed 0·20 less SSB per day compared to those in the control condition (β = 0·25, P = 0·035). There was a trend showing that children exposed to the SNI consumed 0·17 less SSB per day than those in the active control condition (β = 0·20, P = 0·061). No differences were found between conditions for water consumption. However, the moderation effects of descriptive norms (β = –0·12, P = 0·028) and injunctive norms (β = 0·11–0·14, both P = 0·050) indicated that norms are more strongly linked to water consumption in the SNI condition compared to the active control and control conditions. Conclusions: These findings suggest that a SNI promoting healthy drinking behaviours may prevent children from consuming more SSB. Moreover, for water consumption, the prevailing social norms in the context play an important role in mitigating the effectiveness of the SNI.
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13
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Folkvord F, Hermans RCJ. Food Marketing in an Obesogenic Environment: a Narrative Overview of the Potential of Healthy Food Promotion to Children and Adults. CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00338-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Abstract
Purpose of Review
There is abundant evidence that food marketing influences children’s and adults’ food preferences and consumption. As such, exposure to unhealthy food marketing is a widely acknowledged risk factor contributing to the development of overweight and obesity. Less is known about the effects of healthy food promotion on people’s dietary behavior. This narrative review describes research from the past 5 years focused on the effects of healthy food marketing on children’s and adults’ food preferences and dietary intake. Our aim is to gain insight into the potential effects and mechanistic underpinnings of healthy food promotion, thereby building on existing knowledge on underlying mechanisms of the effectiveness of unhealthy food marketing.
Recent Findings
Only a small number of studies directly examined the effects of healthy food promotion on children’s and adults’ dietary behavior. Most studies targeted children’s fruit and/or vegetable intake and used a variety of marketing techniques, ranging from television adverts to social media influencer marketing. Six out of ten studies found a positive effect of healthy food promotion, indicating that healthy food marketing has the potential to influence dietary behavior.
Summary
Food marketing is highly effective in stimulating and reinforcing food consumption, in particular for energy-dense foods. Further investigation and experimentation into the efficiency and effectiveness of healthy food promotion are needed to determine how marketing techniques could be used to improve dietary behavior. The healthy food promotion model provides a framework for future research in this area.
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14
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Franse CB, Boelens M, Fries LR, Constant F, van Grieken A, Raat H. Interventions to increase the consumption of water among children: A systematic review and meta-analysis. Obes Rev 2020; 21:e13015. [PMID: 32167233 PMCID: PMC7317453 DOI: 10.1111/obr.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 12/17/2022]
Abstract
The aim of this study was to conduct a systematic review and meta-analysis on the effectiveness of interventions to increase children's water consumption. A systematic literature search was conducted in seven electronic databases. Studies published in English before 18 February 2019 that evaluated any type of intervention that measured change in water consumption among children aged 2 to 12 years by applying any type of design were included. Of the 47 interventions included in the systematic review, 24 reported a statistically significant increase in water consumption. Twenty-four interventions (17 randomized controlled trials and seven studies with other controlled designs) were included in the meta-analysis. On average, children in intervention groups consumed 29 mL/d (confidence interval [CI] = 13-46 mL/d) more water than did children in control groups. This effect was larger in eight interventions focused specifically on diet (MD = 73 mL/d, CI = 20-126 mL/d) than in 16 interventions focused also on other lifestyle factors (MD = 15 mL/d, CI = 1-29 mL/d). Significant subgroup differences were also found by study setting and socioecological level targeted but not by children's age group, intervention strategy, or study design. In conclusion, there is evidence that, on average, lifestyle interventions can lead to small increases in children's daily water consumption. More research is needed to further understand the specific intervention elements that have the greatest effect.
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Affiliation(s)
- Carmen B. Franse
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Mirte Boelens
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | | | | | - Amy van Grieken
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Hein Raat
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
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15
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Dibay Moghadam S, Krieger JW, Louden DKN. A systematic review of the effectiveness of promoting water intake to reduce sugar-sweetened beverage consumption. Obes Sci Pract 2020; 6:229-246. [PMID: 32523712 PMCID: PMC7278905 DOI: 10.1002/osp4.397] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To examine whether the promotion of water intake could reduce sugar-sweetened beverage (SSB) consumption or purchases independent of interventions that target SSBs. METHODS Seven databases were systematically searched. Included studies used water promotion as the primary intervention; used a controlled trial, single group pre-post, or prospective cohort study design; included a measure of SSB consumption or purchase; enrolled human participants of any age who lived in high-income or middle-income countries; contained original data; and appeared in a peer-reviewed English-language article published from 1 January 2000 to January 4, 2019. The search yielded 7068 publications, from which 108 were chosen for full-text review. Seventeen were included in this review. RESULTS Nine of the 17 studies were randomized controlled trials, six were nonrandomized controlled trials, and 2 were single-group pre-post studies. Participants were primarily children and adolescents. Interventions included water provision, education or promotion activities. Ten of 17 studies were at low or some/moderate risk of bias. Seven studies showed a statistically significant decrease in SSB consumption of which only 2 were at low or some/moderate risk of bias. CONCLUSIONS This review found limited evidence that interventions aimed solely at increasing water consumption reduce SSB intake. Further research is needed to investigate whether interventions that combine water promotion and SSB reduction strategies could be synergistic for reducing SSB intake.
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Affiliation(s)
- Sepideh Dibay Moghadam
- Department of EpidemiologyUniversity of WashingtonWashingtonUnited States of America
- Fred Hutchinson Cancer Research CenterCancer Prevention ProgramWashingtonUnited States of America
| | - James W. Krieger
- Department of Health ServicesUniversity of WashingtonWashingtonUnited States of America
- Healthy Food AmericaWashingtonUnited States of America
| | - Diana K. N. Louden
- University LibrariesUniversity of WashingtonWashingtonUnited States of America
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16
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Smith NR, Zivich PN, Frerichs L. Social Influences on Obesity: Current Knowledge, Emerging Methods, and Directions for Future Research and Practice. Curr Nutr Rep 2020; 9:31-41. [PMID: 31960341 PMCID: PMC7033640 DOI: 10.1007/s13668-020-00302-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Individuals tend to be socially connected with those of similar weight and obesity status. To inform future research and intervention development, we reviewed recent literature examining social influences on weight with a focus on mechanisms of social influence, populations studied, and emerging analytical methods. RECENT FINDINGS Social networks appear to influence weight gain and weight loss. It remains unclear what underlying mechanisms (e.g., social norms, social comparison, behavioral modeling) drive this relationship. Stochastic actor-oriented modeling is an important method in the field, but other work has leveraged natural experiment or randomized designs to study social influence. Future networks and obesity research should examine social influence mechanisms, focus on diverse populations across the life course, and carefully consider how to adequately control for competing factors of social selection and physical environments.
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Affiliation(s)
- Natalie R Smith
- Department of Health Policy and Management, Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Paul N Zivich
- Carolina Population Center, UNC Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, NC, USA.
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