Thorndike, Anne N; Sonnenberg, Lillian; Riis, Jason; Barraclough, Susan; Levy, Douglas E
We assessed whether a 2-phase labeling and choice architecture intervention would increase sales of healthy food and beverages in a large hospital cafeteria. Phase 1 was a 3-month color-coded labeling intervention (red = unhealthy, yellow = less healthy, green = healthy). Phase 2 added a 3-month choice architecture intervention that increased the visibility and convenience of some green items. We compared relative changes in 3-month sales from baseline to phase 1 and from phase 1 to phase 2. At baseline (977,793 items, including 199,513 beverages), 24.9% of sales were red and 42.2% were green. Sales of red items decreased in both phases (P labeling intervention improved sales of healthy items and was enhanced by a choice architecture intervention.
Sonnenberg, Lillian; Riis, Jason; Barraclough, Susan; Levy, Douglas E.
Objectives. We assessed whether a 2-phase labeling and choice architecture intervention would increase sales of healthy food and beverages in a large hospital cafeteria. Methods. Phase 1 was a 3-month color-coded labeling intervention (red = unhealthy, yellow = less healthy, green = healthy). Phase 2 added a 3-month choice architecture intervention that increased the visibility and convenience of some green items. We compared relative changes in 3-month sales from baseline to phase 1 and from phase 1 to phase 2. Results. At baseline (977 793 items, including 199 513 beverages), 24.9% of sales were red and 42.2% were green. Sales of red items decreased in both phases (P beverages. Red beverages decreased 16.5% during phase 1 (P beverages increased 9.6% in phase 1 (P < .001) and further increased 4.0% in phase 2 (P < .001). Bottled water increased 25.8% during phase 2 (P < .001) but did not increase at 2 on-site comparison cafeterias (P < .001). Conclusions. A color-coded labeling intervention improved sales of healthy items and was enhanced by a choice architecture intervention. PMID:22390518
Bos, Colin; Van der Lans, Ivo A; Van Rijnsoever, Frank J; Van Trijp, Hans C M
The increasing prevalence of overweight and obesity poses a major threat to public health. Intervention strategies for healthy food choices potentially reduce obesity rates. Reviews of the effectiveness of interventions, however, show mixed results. To maximise effectiveness, interventions need to be accepted by consumers. The aim of the present study is to explore consumer acceptance of intervention strategies for low-calorie food choices. Beliefs that are associated with consumer acceptance are identified. Data was collected in the Netherlands in 8 semi-structured interviews and 4 focus group discussions (N = 39). Nine archetypical strategies representing educational, marketing and legal interventions served as reference points. Verbatim transcriptions were coded both inductively and deductively with the framework approach. We found that three beliefs are related to consumer acceptance: 1) general beliefs regarding obesity, such as who is responsible for food choice; 2) the perceived effectiveness of interventions; and 3) the perceived fairness of interventions. Furthermore, the different aspects underlying these general and intervention-specific beliefs were identified. General and intervention-specific beliefs are associated with consumer acceptance of interventions for low-calorie food choices. Policymakers in the food domain can use the findings to negotiate the development of interventions and to assess the feasibility of interventions. With respect to future research, we recommend that segments of consumers based on perceptions of intervention strategies are identified.
Background The increasing prevalence of overweight and obesity poses a major threat to public health. Intervention strategies for healthy food choices potentially reduce obesity rates. Reviews of the effectiveness of interventions, however, show mixed results. To maximise effectiveness, interventions need to be accepted by consumers. The aim of the present study is to explore consumer acceptance of intervention strategies for low-calorie food choices. Beliefs that are associated with consumer acceptance are identified. Methods Data was collected in the Netherlands in 8 semi-structured interviews and 4 focus group discussions (N = 39). Nine archetypical strategies representing educational, marketing and legal interventions served as reference points. Verbatim transcriptions were coded both inductively and deductively with the framework approach. Results We found that three beliefs are related to consumer acceptance: 1) general beliefs regarding obesity, such as who is responsible for food choice; 2) the perceived effectiveness of interventions; and 3) the perceived fairness of interventions. Furthermore, the different aspects underlying these general and intervention-specific beliefs were identified. Conclusions General and intervention-specific beliefs are associated with consumer acceptance of interventions for low-calorie food choices. Policymakers in the food domain can use the findings to negotiate the development of interventions and to assess the feasibility of interventions. With respect to future research, we recommend that segments of consumers based on perceptions of intervention strategies are identified. PMID:24225034
Thorndike, Anne N; Riis, Jason; Sonnenberg, Lillian M; Levy, Douglas E
Preventing obesity requires maintenance of healthy eating behaviors over time. Food labels and strategies that increase visibility and convenience of healthy foods (choice architecture) promote healthier choices, but long-term effectiveness is unknown. Assess effectiveness of traffic-light labeling and choice architecture cafeteria intervention over 24 months. Longitudinal pre-post cohort follow-up study between December 2009 and February 2012. Data were analyzed in 2012. Large hospital cafeteria with a mean of 6511 transactions daily. Cafeteria sales were analyzed for (1) all cafeteria customers and (2) a longitudinal cohort of 2285 hospital employees who used the cafeteria regularly. After a 3-month baseline period, cafeteria items were labeled green (healthy); yellow (less healthy); or red (unhealthy) and rearranged to make healthy items more accessible. Proportion of cafeteria sales that were green or red during each 3-month period from baseline to 24 months. Changes in 12- and 24-month sales were compared to baseline for all transactions and transactions by the employee cohort. The proportion of sales of red items decreased from 24% at baseline to 20% at 24 months (pchoice architecture cafeteria intervention resulted in sustained healthier choices over 2 years, suggesting that food environment interventions can promote long-term changes in population eating behaviors. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.
Thorndike, Anne N.; Riis, Jason; Sonnenberg, Lillian M.; Levy, Douglas E.
Background Preventing obesity requires maintenance of healthy eating behaviors over time. Food labels and strategies that increase visibility and convenience of healthy foods (choice architecture) promote healthier choices, but long-term effectiveness is unknown. Purpose Assess effectiveness of traffic-light labeling and choice architecture cafeteria intervention over 24 months. Design Longitudinal pre–post cohort follow-up study between December 2009 and February 2012. Data were analyzed in 2012. Setting/participants Large hospital cafeteria with mean of 6511 transactions daily. Cafeteria sales were analyzed for: (1) all cafeteria customers and (2) longitudinal cohort of 2285 hospital employees who used the cafeteria regularly. Intervention After 3-month baseline period, cafeteria items were labeled green (healthy), yellow (less healthy) or red (unhealthy) and rearranged to make healthy items more accessible. Main outcome measures Proportion of cafeteria sales that were green or red during each 3-month period from baseline to 24 months. Changes in 12- and 24-month sales were compared to baseline for all transactions and transactions by the employee cohort. Results The proportion of sales of red items decreased from 24% at baseline to 20% at 24 months (p<0.001), and green sales increased from 41% to 46% (p<0.001). Red beverages decreased from 26% of beverage sales at baseline to 17% at 24 months (p<0.001); green beverages increased from 52% to 60% (p<0.001). Similar patterns were observed for the cohort of employees, with largest change for red beverages (23% to 14%, p<0.001). Conclusions A traffic-light and choice architecture cafeteria intervention resulted in sustained healthier choices over 2 years, suggesting food environment interventions can promote long-term changes in population eating behaviors. PMID:24439347
The need for more effective interventions to combat the obesity problem has been expressed by many public health experts. While consumer support is important for intervention effectiveness, little is known about why consumers accept or do not accept food choice interventions. The present thesis
Joseph, Laura S; Gorin, Amy A; Mobley, Stacey L; Mobley, Amy R
Novel interventions within child care settings are needed for childhood obesity prevention. The aim of this study was to determine the impact of a short-term nutrition education pilot intervention on preschool-age children's snack food choices. Children ages 3-5 years (n = 49) from one child care setting participated in a short-term nutrition education intervention (nine 30-minute interactive lessons) taught over a 2-week period. Pre-post assessments included snack knowledge and snack preference questionnaires and an observed snack selection trial to allow children to choose between a healthy and unhealthy snack choice similar to the current food environment. Children's height and weight were measured and BMI z-scores calculated. Parental reports of demographics and child's food preferences were also collected at baseline. Children significantly improved their preference of healthier snacks (p = 0.03) and the ability to distinguish them (p = 0.03) from other snacks. However, they did not significantly improve (p > 0.05) their snack choice between a healthy and unhealthy choice immediately after the short-term nutrition education program. Children who were younger (p = 0.003) or who had higher nutrition knowledge scores (p = 0.002) were more likely to select the healthy snack after the intervention. This study provides evidence that a short-term nutrition education program improves preschool children's knowledge about healthy snacks, but does not translate to immediate healthier snack selections for all children. Future research should investigate the optimal duration of a nutrition education program in a child care setting and other external influences (parents, policy) most influential on snack choice and eventual obesity risk.
Tarro, Lucia; Aceves-Martins, Magaly; Tiñena, Yolanda; Parisi, Joan Lluís; Blasi, Xavier; Giralt, Montse; Llauradó, Elisabet; Solà, Rosa
Restaurant-based interventions can be an enjoyable way to encourage healthier eating choices by all members of a family. Thus, the principal aims of this study were a) to promote healthy diets by increasing healthy food offerings and b) to increase the number of foods offered specifically as gluten-free and lactose-free and to inform patrons by including nutritional and allergen information that complies with Regulation 1169/2011 regarding the food served in restaurants, takeaways and snack bars. A restaurant-based intervention was implemented at 16 food establishments at 2 resorts (the Cambrils Park Resort and Camping Sangulí, Spain, from 2014 to 2015) based on the following 4 components: 1) providing nutritional and allergen analyses of the offered dishes, 2) increasing the number of healthy food choices, 3) identifying menu items associated with allergies and intolerance, and 4) training staff on healthy eating and allergens. Customer satisfaction regarding food aspects was assessed using surveys (10-point scale). Both resorts significantly increased their offerings of healthy dishes (28.6% to 44.7%; P = 0.003) and desserts with fruit (20% to 51.3%; P = 0.013), thus obtaining the Spanish Government's Mediterranean Diet certification. Additionally, both resorts obtained Catalan Celiac Association certification. Moreover, both resorts significantly increased their percentages of gluten-free dishes (2.1% to 50.5%; P restaurant-based intervention expanded the number of healthy and allergen-free foods offered in a family-oriented holiday resort environment to encourage healthy food choices, resulting in increased customer satisfaction.
Full Text Available Abstract Background Restaurant-based interventions can be an enjoyable way to encourage healthier eating choices by all members of a family. Thus, the principal aims of this study were a to promote healthy diets by increasing healthy food offerings and b to increase the number of foods offered specifically as gluten-free and lactose-free and to inform patrons by including nutritional and allergen information that complies with Regulation 1169/2011 regarding the food served in restaurants, takeaways and snack bars. Methods A restaurant-based intervention was implemented at 16 food establishments at 2 resorts (the Cambrils Park Resort and Camping Sangulí, Spain, from 2014 to 2015 based on the following 4 components: 1 providing nutritional and allergen analyses of the offered dishes, 2 increasing the number of healthy food choices, 3 identifying menu items associated with allergies and intolerance, and 4 training staff on healthy eating and allergens. Customer satisfaction regarding food aspects was assessed using surveys (10-point scale. Results Both resorts significantly increased their offerings of healthy dishes (28.6% to 44.7%; P = 0.003 and desserts with fruit (20% to 51.3%; P = 0.013, thus obtaining the Spanish Government’s Mediterranean Diet certification. Additionally, both resorts obtained Catalan Celiac Association certification. Moreover, both resorts significantly increased their percentages of gluten-free dishes (2.1% to 50.5%; P < 0.001 and lactose-free dishes (5.5% to 37.5%; P < 0.001 after the intervention. Customer satisfaction increased (mean ± standard deviation from 6.9 ± 1.6 to 8.5 ± 1.5 (P < 0.001. Conclusion This restaurant-based intervention expanded the number of healthy and allergen-free foods offered in a family-oriented holiday resort environment to encourage healthy food choices, resulting in increased customer satisfaction.
Wright, Breanna; Bragge, Peter
To synthesize review research pertaining to the effectiveness of interventions in dining-out settings to reduce food/calorie consumption. A rapid review methodology was employed to focus on synthesized research. A comprehensive search for peer-reviewed systematic reviews from 2010 to 2015 yielded 1,847 citations. Following screening, ten systematic reviews were included. The 10 included systematic reviews identified 183 primary studies evaluating evidence in three behavioural intervention areas: social models/norms, manipulation of size, and provision of health information. Three systematic reviews evaluating the use of social models/norms found this was an effective intervention for influencing food intake. Five systematic reviews that assessed manipulation of portion/dishware/cutlery size found a small-to-moderate effect on food consumption. Three systematic reviews looked at the provision of health information, which was not effective alone; however, in combination with contextual or interpretive material such as traffic lights or exercise equivalence, this was shown to reduce calorie consumption. One systematic review covered two topic areas. The results indicate that policies or interventions that aim to improve healthy choices or consumption when dining out would benefit from harnessing social norms and positive positioning of social identity. Furthermore, provision of health information should always be accompanied by an interpretative guide, such as traffic lights. Manipulation of plate/portion/cutlery size may be effective; however, the effect size is small and further research is required to investigate whether this effect is retained in overweight or obese populations. Statement of contribution What is already known on this subject? Eating behaviours (food choices, consumption) have played a role in the obesity epidemic. Behavioural 'nudges' have tried to increase healthier eating choices. What does this study add? Social norms and modelling have a
Guldborg Hansen, Pelle; Skov, Laurits Rohden; Lund Skov, Katrine
. However, integration and testing of the nudge approach as part of more comprehensive public health strategies aimed at making healthy choices easier is being threatened by inadequate understandings of its scientific character, relationship with regulation and its ethical implications. This article reviews...... working with or incorporating the nudge approach into programs or policies aimed at making healthy choices easier...
Full Text Available Introduction: Central adiposity and metabolic syndrome are quite common among postmenopausal women. Dietary diversity and healthy food choices have essential role in health and also in prevention of obesity. The main objective of this study was to evaluate the impact of mobile phone short messaging system on healthy food choices among Iranian postmenopausal women. Materials and Methods: This was a randomized controlled trial in which 100 postmenopausal women aged 40-60 years were recruited and assigned to two groups (50 each in the intervention and control groups. Food frequency consumption was measured using a questionnaire. A total of 16 text messages including information about modification of food selection (healthy choices, benefits, methods, etc., were sent to participants in the intervention group during 4 months follow-up (1/week. The Chi-square and independent t-test used for data analysis. Ninety-two women completed the study. Results: The consumption of Vitamin A rich fruits and vegetables significantly increased in the intervention group compared to the control group (P < 0.001. More women in the intervention group consumed fish after intervention (P = 0.02. The consumption of green leafy vegetables showed a nonsignificant increase in the intervention group. Conclusion: Using mobile phone short messaging system can improve the healthy food choices regarding Vitamin A rich fruits and vegetables and fish among postmenopausal women.
Thorndike, Anne N.; Riis, Jason; Levy, Douglas E.
Population-level strategies to improve healthy food choices are needed for obesity prevention. We conducted a randomized controlled trial of 2,672 employees at Massachusetts General Hospital who were regular customers of the hospital cafeteria with all items labeled green (healthy), yellow (less healthy), or red (unhealthy) to determine if social norm (peer-comparison) feedback with or without financial incentives increased employees’ healthy food choices. Participants were randomized in 2012 to three arms: 1) monthly letter with social norm feedback about healthy food purchases, comparing employee to “all” and to “healthiest” customers (feedback-only); 2) monthly letter with social norm feedback plus small financial incentive for increasing green purchases (feedback-incentive); or 3) no contact (control). The main outcome was change in proportion of green-labeled purchases at end of 3-month intervention. Post-hoc analyses examined linear trends. At baseline, the proportion of green-labeled purchases (50%) did not differ between arms. At end of the 3-month intervention, the percentage increase in green-labeled purchases was larger in the feedback-incentive arm compared to control (2.2% vs. 0.1%, P=0.03), but the two intervention arms were not different. The rate of increase in green-labeled purchases was higher in both feedback-only (P=0.04) and feedback-incentive arms (P=0.004) compared to control. At end of a 3-month wash-out, there were no differences between control and intervention arms. Social norms plus small financial incentives increased employees’ healthy food choices over the short-term. Future research will be needed to assess the impact of this relatively low-cost intervention on employees’ food choices and weight over the long-term. Trial Registration: Clinical Trials.gov NCT01604499 PMID:26827617
Vakili, Mahdis; Abedi, Parvin; Afshari, Poorandokht; Kaboli, Nayereh Esmael
Central adiposity and metabolic syndrome are quite common among postmenopausal women. Dietary diversity and healthy food choices have essential role in health and also in prevention of obesity. The main objective of this study was to evaluate the impact of mobile phone short messaging system on healthy food choices among Iranian postmenopausal women. This was a randomized controlled trial in which 100 postmenopausal women aged 40-60 years were recruited and assigned to two groups (50 each in the intervention and control groups). Food frequency consumption was measured using a questionnaire. A total of 16 text messages including information about modification of food selection (healthy choices, benefits, methods, etc.,) were sent to participants in the intervention group during 4 months follow-up (1/week). The Chi-square and independent t-test used for data analysis. Ninety-two women completed the study. The consumption of Vitamin A rich fruits and vegetables significantly increased in the intervention group compared to the control group (P mobile phone short messaging system can improve the healthy food choices regarding Vitamin A rich fruits and vegetables and fish among postmenopausal women.
Ayala, Guadalupe X; Castro, Iana A; Pickrel, Julie L; Williams, Christine B; Lin, Shih-Fan; Madanat, Hala; Jun, Hee-Jin; Zive, Michelle
completed, providing evidence that the restaurant industry is open to working on the public health challenge of childhood obesity. Determining whether a restaurant intervention can promote sales of healthy children's menu items will provide evidence for how to create environments that support the healthy choices needed to prevent and control obesity. Despite these strengths, collection of sales data that will allow comprehensive analysis of intervention effects remains a challenge. NCT02511938.
Scherr, Rachel E; Linnell, Jessica D; Smith, Martin H; Briggs, Marilyn; Bergman, Jacqueline; Brian, Kelley M; Dharmar, Madan; Feenstra, Gail; Hillhouse, Carol; Keen, Carl L; Nguyen, Lori M; Nicholson, Yvonne; Ontai, Lenna; Schaefer, Sara E; Spezzano, Theresa; Steinberg, Francene M; Sutter, Carolyn; Wright, Janel E; Young, Heather M; Zidenberg-Cherr, Sheri
To provide a framework for implementation of multicomponent, school-based nutrition interventions. This article describes the research methods for the Shaping Healthy Choices Program, a model to improve nutrition and health-related knowledge and behaviors among school-aged children. Longitudinal, pretest/posttest, randomized, controlled intervention. Four elementary schools in California. Fourth-grade students at intervention (n = 252) and control (n = 238) schools and their parents and teachers. Power analyses demonstrate that a minimum of 159 students per group will be needed to achieve sufficient power. The sample size was determined using the variables of nutrition knowledge, vegetable preference score, and body mass index percentile. A multicomponent school-based nutrition education intervention over 1 academic year, followed by activities to support sustainability of the program. Dietary and nutrition knowledge and behavior, critical thinking skills, healthy food preferences and consumption, and physical activity will be measured using a nutrition knowledge questionnaire, a food frequency questionnaire, a vegetable preferences assessment tool, the Test of Basic Science Process Skills, digital photography of plate waste, PolarActive accelerometers, anthropometrics, a parent questionnaire, and the School and Community Actions for Nutrition survey. Evaluation will include quantitative and qualitative measures. Quantitative data will use paired t, chi-square, and Mann-Whitney U tests and regression modeling using P = .05 to determine statistical significance. Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Tasdemir-Ozdes, Aylin; Strickland-Hughes, Carla M; Bluck, Susan; Ebner, Natalie C
Regardless of age, making healthy lifestyle choices is prudent. Despite that, individuals of all ages sometimes have difficulty choosing the healthy option. We argue that individuals' view of the future and position in the life span affects their current lifestyle choices. We capture the multidimensionality of future thinking by assessing 3 types of future perspective. Younger and older men and women (N = 127) reported global future time perspective, future health perspective, and perceived importance of future health-related events. They also rated their likelihood of making healthy lifestyle choices. As predicted, older participants indicated greater intention to make healthy choices in their current life than did younger participants. Compared to younger participants, older participants reported shorter global future time perspective and anticipated worse future health but perceived future health-related events as more important. Having a positive view of one's future health and seeing future health-related events as important were related to greater intention to make healthy lifestyle choices, but greater global future time perspective was not directly related to healthy choices. However, follow-up analyses suggested that greater global future time perspective indirectly affected healthy choices via a more positive view of future health. None of these relations were moderated by age. Individuals' perspective on the future is shown to be an important multidimensional construct affecting everyday healthy lifestyle choices for both younger and older adults. Implications for encouraging healthy choices across the adult life span are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Guadalupe X. Ayala
fidelity. Discussion Successful recruitment of the restaurants has been completed, providing evidence that the restaurant industry is open to working on the public health challenge of childhood obesity. Determining whether a restaurant intervention can promote sales of healthy children’s menu items will provide evidence for how to create environments that support the healthy choices needed to prevent and control obesity. Despite these strengths, collection of sales data that will allow comprehensive analysis of intervention effects remains a challenge. Trial registration NCT02511938
Full Text Available The present study investigates acceptance of intervention strategies for low-calorie snack choices that vary regarding the effect they have on consumers’ freedom of choice (providing information, guiding choice through (disincentives, and restricting choice. We examine the mediating effects of perceived effectiveness and perceived fairness, and the moderating effects of barriers to choose low-calorie snacks and perceived responsibility for food choice. Data was collected through an online survey, involving three waves that were completed over a seven week timespan. Information was collected on barriers and perceived responsibility, and evaluations of a total of 128 intervention strategies with varying levels of intrusiveness that were further systematically varied in terms of source, location, approach/avoidance, type, and severity. A total of 1173 respondents completed all three waves. We found that the effect of intervention intrusiveness on acceptance was mediated by the perceived personal- and societal effectiveness, and the perceived fairness of interventions. For barriers and perceived responsibility, only main effects on intervention-specific beliefs were found. Government interventions were accepted less than interventions by food manufacturers. In conclusion, the present study shows that acceptance of interventions depends on perceptions of personal- and societal effectiveness and fairness, thereby providing novel starting points for increasing acceptance of both existing and new food choice interventions.
Bos, Colin; Van Der Lans, Ivo; Van Rijnsoever, Frank; Van Trijp, Hans
The present study investigates acceptance of intervention strategies for low-calorie snack choices that vary regarding the effect they have on consumers’ freedom of choice (providing information, guiding choice through (dis)incentives, and restricting choice). We examine the mediating effects of perceived effectiveness and perceived fairness, and the moderating effects of barriers to choose low-calorie snacks and perceived responsibility for food choice. Data was collected through an online survey, involving three waves that were completed over a seven week timespan. Information was collected on barriers and perceived responsibility, and evaluations of a total of 128 intervention strategies with varying levels of intrusiveness that were further systematically varied in terms of source, location, approach/avoidance, type, and severity. A total of 1173 respondents completed all three waves. We found that the effect of intervention intrusiveness on acceptance was mediated by the perceived personal- and societal effectiveness, and the perceived fairness of interventions. For barriers and perceived responsibility, only main effects on intervention-specific beliefs were found. Government interventions were accepted less than interventions by food manufacturers. In conclusion, the present study shows that acceptance of interventions depends on perceptions of personal- and societal effectiveness and fairness, thereby providing novel starting points for increasing acceptance of both existing and new food choice interventions. PMID:26389949
Bos, Colin; Lans, Ivo Van Der; Van Rijnsoever, Frank; Van Trijp, Hans
The present study investigates acceptance of intervention strategies for low-calorie snack choices that vary regarding the effect they have on consumers' freedom of choice (providing information, guiding choice through (dis)incentives, and restricting choice). We examine the mediating effects of perceived effectiveness and perceived fairness, and the moderating effects of barriers to choose low-calorie snacks and perceived responsibility for food choice. Data was collected through an online survey, involving three waves that were completed over a seven week timespan. Information was collected on barriers and perceived responsibility, and evaluations of a total of 128 intervention strategies with varying levels of intrusiveness that were further systematically varied in terms of source, location, approach/avoidance, type, and severity. A total of 1173 respondents completed all three waves. We found that the effect of intervention intrusiveness on acceptance was mediated by the perceived personal- and societal effectiveness, and the perceived fairness of interventions. For barriers and perceived responsibility, only main effects on intervention-specific beliefs were found. Government interventions were accepted less than interventions by food manufacturers. In conclusion, the present study shows that acceptance of interventions depends on perceptions of personal- and societal effectiveness and fairness, thereby providing novel starting points for increasing acceptance of both existing and new food choice interventions.
... Conditions Prevention and Wellness Staying Healthy Healthy Living Travel Occupational Health First Aid and Injury Prevention Crisis Situations Pets and Animals myhealthfinder Food and Nutrition Healthy Food Choices Weight Loss and ...
Full Text Available Abstract: Interventions aimed at changing dietary patterns should be designed based on the main motives underlying the food choices of specific target populations. The aim of the present study was to identify motives underlying food choice and barriers to healthy eating among consumers in two socioeconomic levels in Uruguay. Eleven focus groups were carried out with a total of 76 participants. Six of the groups involved low income participants and the others were conducted with middle income participants. Discussions were held around frequently consumed products, motives underlying food choices and barriers to healthy eating. Results confirmed the strong influence of income level on motives underlying food choice and barriers to the adoption of healthy eating. Low income participants described their choices as mainly driven by economic factors and satiety, whereas convenience was the main determinant of food selection for middle income participants. Implications for the design of public policies targeted at each group are discussed.
Ares, Gastón; Machín, Leandro; Girona, Alejandra; Curutchet, María Rosa; Giménez, Ana
Interventions aimed at changing dietary patterns should be designed based on the main motives underlying the food choices of specific target populations. The aim of the present study was to identify motives underlying food choice and barriers to healthy eating among consumers in two socioeconomic levels in Uruguay. Eleven focus groups were carried out with a total of 76 participants. Six of the groups involved low income participants and the others were conducted with middle income participants. Discussions were held around frequently consumed products, motives underlying food choices and barriers to healthy eating. Results confirmed the strong influence of income level on motives underlying food choice and barriers to the adoption of healthy eating. Low income participants described their choices as mainly driven by economic factors and satiety, whereas convenience was the main determinant of food selection for middle income participants. Implications for the design of public policies targeted at each group are discussed.
Bos, C.; Lans, van der I.A.; Rijnsoever, F.J.; Trijp, van J.C.M.
The present study investigates acceptance of intervention strategies for low-calorie snack choices that vary regarding the effect they have on consumers’ freedom of choice (providing information, guiding choice through (dis)incentives, and restricting choice). We examine the mediating effects of
Papies, Esther K; Veling, Harm
There is a growing consensus that our food-rich living environment contributes to rising numbers of people with overweight and obesity. Low-cost, effective intervention tools are needed to facilitate healthy eating behavior, especially when eating away from home. Therefore, we present a field experiment in a restaurant that tested whether providing subtle environmental diet reminders increases low-calorie food choices among both chronic and current dieters. For half of the participants, the menu was supplemented with diet-related words, as reminders of healthy eating and dieting. We recorded customers' choices of low-calorie or high-calorie items from the menu, and we assessed chronic and current dieting. Consistent with our hypotheses, we found that diet reminders increased choices for low-calorie foods, among both chronic and current dieters. After a diet reminder, around half of dieters made a healthy menu choice. This study demonstrates the efficacy of providing subtle diet reminders as a low-cost practical intervention to increase low-calorie food choices among weight-concerned individuals, who are motivated to regulate their eating behavior but have been found to often fail in food-rich environments. Copyright © 2012 Elsevier Ltd. All rights reserved.
Salmon, Stefanie J; Fennis, Bob M; de Ridder, Denise T D; Adriaanse, Marieke A; de Vet, Emely
Food choices are often made mindlessly, when individuals are not able or willing to exert self-control. Under low self-control, individuals have difficulties to resist palatable but unhealthy food products. In contrast to previous research aiming to foster healthy choices by promoting high self-control, this study exploits situations of low self-control, by strategically using the tendency under these conditions to rely on heuristics (simple decision rules) as quick guides to action. More specifically, the authors associated healthy food products with the social proof heuristic (i.e., normative cues that convey majority endorsement for those products). One hundred seventy-seven students (119 men), with an average age of 20.47 years (SD = 2.25) participated in the experiment. This study used a 2 (low vs. high self-control) × 2 (social proof vs. no heuristic) × 2 (trade-off vs. control choice) design, with the latter as within-subjects factor. The dependent variable was the number of healthy food choices in a food-choice task. In line with previous studies, people made fewer healthy food choices under low self-control. However, this negative effect of low self-control on food choice was reversed when the healthy option was associated with the social proof heuristic. In that case, people made more healthy choices under conditions of low self-control. Low self-control may be even more beneficial for healthy food choices than high self-control in the presence of a heuristic. Exploiting situations of low self-control is a new and promising method to promote health on impulse. PsycINFO Database Record (c) 2014 APA, all rights reserved.
Koelen, M.A.; Lindström, B.
An important goal of health promotion is to make it easier for people to make healthy choices. However, this may be difficult if people do not feel control over their environment and their personal circumstances. An important concept in relation to this is empowerment. Health professionals are
Mueller Loose, Simone; Peschel, Anne; Grebitus, Carola
Although seafood is considered to be a healthy food choice, the recommended consumption level of two servings per week is still not reached in most countries. Previous research has identified potential barriers of seafood consumption, including purchase and consumption convenience, but it is still...... participated in an online choice experiment with visual product stimuli to simulate their choice of oysters in a retail store. Considering preference heterogeneity respondents’ choices were analyzed with a scale adjusted latent class model and six different consumer segments differing in their preferences were...
Sun, Yu-Hua Christine
This study addresses how various health concerns might influence not only consumers' food choice motives but also consumers' subsequent attitudes toward healthy eating. This study expects that those consumers with greater health concerns would have different food choice motives and better attitudes toward healthy eating. A self-completion questionnaire was used to gather information. Participants, a random sample of 500 undergraduate students from a national university in Taipei, Taiwan, provided a total of 456 usable questionnaires, representing a valid response rate of 91%. The average age of the respondents at the time of the survey was 21 years and 63% of respondents were females. The relationship between health concern and healthy eating attitudes was confirmed. The relationship between health concern of developing diseases and attitudes toward healthy eating was fully mediated by food choice motives. However, the relationship between calorie consumption health concern and healthy eating attitudes was only partially mediated by food choice motives. Implications of these findings are discussed.
Provencher, Véronique; Jacob, Raphaëlle
Healthy eating is an important determinant of health, but adherence to dietary guidelines remains a public health concern. Identifying factors that impact dietary habits is therefore important to facilitate healthy eating. One widely used strategy to help consumers make healthier food choices is nutrition information, such as labeling and claims. Despite the intention of these strategies to improve decision making, they can also be misunderstood or misinterpreted by consumers. The aim of this review is to explore food perceptions by examining how cognitive factors influence perceived healthiness of food, and the impact of perceived healthiness of food on food choices and intake. Overall findings of this review suggest that cognitive factors, such as type of food and branding, significantly contribute to judgmental bias and have an impact on perceived healthiness while not consistently or systematically influencing choice and intake.
Valdivia Espino, Jennifer N; Guerrero, Natalie; Rhoads, Natalie; Simon, Norma-Jean; Escaron, Anne L; Meinen, Amy; Nieto, F Javier; Martinez-Donate, Ana P
Eating in restaurants is associated with high caloric intake. This review summarizes and evaluates the evidence supporting community-based restaurant interventions. We searched all years of PubMed and Web of Knowledge through January 2014 for original articles describing or evaluating community-based restaurant interventions to promote healthy eating. We extracted summary information and classified the interventions into 9 categories according to the strategies implemented. A scoring system was adapted to evaluate the evidence, assigning 0 to 3 points to each intervention for study design, public awareness, and effectiveness. The average values were summed and then multiplied by 1 to 3 points, according to the volume of research available for each category. These summary scores were used to determine the level of evidence (insufficient, sufficient, or strong) supporting the effectiveness of each category. This review included 27 interventions described in 25 studies published since 1979. Most interventions took place in exclusively urban areas of the United States, either in the West or the South. The most common intervention categories were the use of point-of-purchase information with promotion and communication (n = 6), and point-of-purchase information with increased availability of healthy choices (n = 6). Only the latter category had sufficient evidence. The remaining 8 categories had insufficient evidence because of interventions showing no, minimal, or mixed findings; limited reporting of awareness and effectiveness; low volume of research; or weak study designs. No intervention reported an average negative impact on outcomes. Evidence about effective community-based strategies to promote healthy eating in restaurants is limited, especially for interventions in rural areas. To expand the evidence base, more studies should be conducted using robust study designs, standardized evaluation methods, and measures of sales, behavior, and health outcomes.
Pechey, Rachel; Monsivais, Pablo
Investigations of the contribution of food costs to socioeconomic inequalities in diet quality may have been limited by the use of estimated (vs. actual) food expenditures, not accounting for where individuals shop, and possible reverse mediation between food expenditures and healthiness of food choices. This study aimed to explore the extent to which food expenditure mediates socioeconomic inequalities in the healthiness of household food choices. Observational panel data on take-home food and beverage purchases, including expenditure, throughout 2010 were obtained for 24,879 UK households stratified by occupational social class. Purchases of (1) fruit and vegetables and (2) less-healthy foods/beverages indicated healthiness of choices. Supermarket choice was determined by whether households ever visited market-defined high-price and/or low-price supermarkets. Results showed that higher occupational social class was significantly associated with greater food expenditure, which was in turn associated with healthier purchasing. In mediation analyses, 63% of the socioeconomic differences in choices of less-healthy foods/beverages were mediated by expenditure, and 36% for fruit and vegetables, but these figures were reduced to 53% and 31% respectively when controlling for supermarket choice. However, reverse mediation analyses were also significant, suggesting that 10% of socioeconomic inequalities in expenditure were mediated by healthiness of choices. Findings suggest that lower food expenditure is likely to be a key contributor to less-healthy food choices among lower socioeconomic groups. However, the potential influence of cost may have been overestimated previously if studies did not account for supermarket choice or explore possible reverse mediation between expenditure and healthiness of choices. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
Linnell, Jessica D; Zidenberg-Cherr, Sheri; Briggs, Marilyn; Scherr, Rachel E; Brian, Kelley M; Hillhouse, Carol; Smith, Martin H
To examine the use of a systematic approach and theoretical framework to develop an inquiry-based, garden-enhanced nutrition curriculum for the Shaping Healthy Choices Program. Curriculum development occurred in 3 steps: identification of learning objectives, determination of evidence of learning, and activity development. Curriculum activities were further refined through pilot-testing, which was conducted in 2 phases. Formative data collected during pilot-testing resulted in improvements to activities. Using a systematic, iterative process resulted in a curriculum called Discovering Healthy Choices, which has a strong foundation in Social Cognitive Theory and constructivist learning theory. Furthermore, the Backward Design method provided the design team with a systematic approach to ensure activities addressed targeted learning objectives and overall Shaping Healthy Choices Program goals. The process by which a nutrition curriculum is developed may have a direct effect on student outcomes. Processes by which nutrition curricula are designed and learning objectives are selected, and how theory and pedagogy are applied should be further investigated so that effective approaches to developing garden-enhanced nutrition interventions can be determined and replicated. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
He, Ka; Kramer, Ellen; Houser, Robert F; Chomitz, Virginia R; Hacker, Karen A
To: (a) establish criteria for defining positive health behaviors and lifestyle; and (b) identify characteristics of adolescents who practice a healthy lifestyle. Responses from a 1998 survey via questionnaire, of 1487 students, from a public high school, Cambridge, Massachusetts, were used to assess correlates of healthy lifestyle choices. Strict and broad assessments of healthy behaviors were defined for students: use of alcohol, tobacco, and illegal drugs; sexual behavior; attempted suicide. Whereas the "strict" criteria included only those adolescents who did not practice any of the behaviors in question, the broad criteria reflected experimentation and moderate risk-taking. The prevalence of positive behaviors was assessed by demographic and student characteristics. In addition, logistic regression models were created to predict determinants of teenagers' healthy lifestyles using both strict and broad definitions. Using strict criteria of healthy lifestyle, significant predictors were being female, born outside the United States, higher academic performance, and fewer stressful life events. Using a broad definition of a healthy lifestyle, significant predictors were being non-Caucasian, in the lower grade levels at the school, higher academic performance, and fewer stressful life events. In both models, peers' approval of risky behaviors negatively influenced teens' lifestyles, whereas parents' disapproval of risky behaviors was a positive influence. These results reinforce the importance of school, peer, and parent support of positive behaviors. It is important for public health workers and families to understand and define healthy lifestyles choices for adolescents.
... kids to be active. When it comes to food and physical activity, what you say and do around your children can have a lasting effect. Work ... Choices Help Kids Form Healthy Habits Be a role model. Eat healthy family meals together. Walk or ride ...
McEvoy, C. T.; Lawton, J.; Kee, F.; Young, I. S.; Woodside, J. V.; McBratney, J.; McKinley, M. C.
Using rewards may be an effective method to positively influence adolescent eating behaviour, but evidence regarding this approach is limited. The aim of this study was to explore young adolescent views about a proposed reward intervention associated with food choice in school canteens. Focus groups were held in 10 schools located in lower…
Weijzen, P.L.G.; Graaf, de C.; Dijksterhuis, G.B.
The present study investigated the factors that affect the intention¿behaviour consistency of healthy snack choices. Intended snack choice was assessed by asking participants (N = 538) to choose a snack on paper, out of 8 snacks (4 healthy, e.g. melon and gingerbread, and 4 unhealthy, e.g. crisps
Objective: To determine whether 4th-grade students participating in the Shaping Healthy Choices Program (SHCP), a school-based nutrition intervention, change vegetable intake Design: quasi-experimental single group pre-test, post-test with a self-selected, convenience sample of students recruited at...
Cheung, Tracy T L; Kroese, Floor M; Fennis, Bob M; De Ridder, Denise T D
The majority of existing research and conventional wisdom would advise against shopping on an empty stomach as hunger is assumed to encourage impulsive choices that typically lead to self-control failure (i.e., favouring short-term gratifications at the expense of long-term goals). Nonetheless, through two studies the current research aims to demonstrate that hungry consumers would not always be disadvantaged when encountering a self-control conflict involving a trade-off choice between a healthy vs. a more palatable but unhealthy choice. Particularly we posit that the choice outcome of the self-control conflict is dependent on contextual cues, such that hungry consumers with the tendency to make fast decisions could benefit from following a social proof heuristic promoting the healthy options. In Study 1, we indeed observed participants' self-reported hunger to be negatively associated with state self-control, but as most participants generally experienced low levels of hunger we did not observe apparent effects of hunger on food choice (DV), and correspondingly the potential influence of the social proof heuristic in moderating the choice outcome. However, in Study 2 where hunger was manipulated, we found hungry participants making significantly less healthy choices than satiated participants, but a social proof heuristic mitigated this effect (i.e., in the presence of social proof heuristic hungry participants made just as many healthy food choices as satiated participants; and hungry participants made more healthy choices in the social proof condition than in the no heuristic condition). These findings support our approach of providing contextual cues in the environment in order to work with, rather than against, the impulsivity triggered by hunger to promote successful self-control behaviours. Copyright © 2017 Elsevier Ltd. All rights reserved.
Ensaff, Hannah; Homer, Matt; Sahota, Pinki; Braybrook, Debbie; Coan, Susan; McLeod, Helen
With growing evidence for the positive health outcomes associated with a plant-based diet, the study's purpose was to examine the potential of shifting adolescents' food choices towards plant-based foods. Using a real world setting of a school canteen, a set of small changes to the choice architecture was designed and deployed in a secondary school in Yorkshire, England. Focussing on designated food items (whole fruit, fruit salad, vegetarian daily specials, and sandwiches containing salad) the changes were implemented for six weeks. Data collected on students' food choice (218,796 transactions) enabled students' (980 students) selections to be examined. Students' food choice was compared for three periods: baseline (29 weeks); intervention (six weeks); and post-intervention (three weeks). Selection of designated food items significantly increased during the intervention and post-intervention periods, compared to baseline (baseline, 1.4%; intervention 3.0%; post-intervention, 2.2%) χ(2)(2) = 68.1, p food items during the intervention period, compared to baseline. The study's results point to the influence of choice architecture within secondary school settings, and its potential role in improving adolescents' daily food choices.
Hardcastle, Sarah J; Thøgersen-Ntoumani, Cecilie; Chatzisarantis, Nikos L D
In this Special Issue, entitled "Food choice and Nutrition: A Social Psychological Perspective", three broad themes have been identified: (1) social and environmental influences on food choice; (2) psychological influences on eating behaviour; and (3) eating behaviour profiling.The studies that addressed the social and environmental influences indicated that further research would do well to promote positive food choices rather than reduce negative food choices; promote the reading and interpretation of food labels and find ways to effectively market healthy food choices through accessibility, availability and presentation. The studies on psychological influences found that intentions, perceived behavioural control, and confidence were predictors of healthy eating. Given the importance of psychological factors, such as perceived behavioural control and self-efficacy, healthy eating interventions should reduce barriers to healthy eating and foster perceptions of confidence to consume a healthy diet. The final theme focused on the clustering of individuals according to eating behaviour. Some "types" of individuals reported more frequent consumption of fast foods, ready meals or convenience meals or greater levels of disinhibitiona nd less control over food cravings. Intervention designs which make use of multi-level strategies as advocated by the Ecological Model of Behaviour change that proposes multi-level (combining psychological, social and environmental) strategies are likely to be more effective in reaching and engaging individuals susceptible to unhealthy eating habits than interventions operating on a single level.
Substituting sugar confectionery with fruit and healthy snacks at checkout - a win-win strategy for consumers and food stores? a study on consumer attitudes and sales effects of a healthy supermarket intervention.
Winkler, Lise L; Christensen, Ulla; Glümer, Charlotte; Bloch, Paul; Mikkelsen, Bent E; Wansink, Brian; Toft, Ulla
The widespread use of in-store marketing strategies to induce unhealthy impulsive purchases has implications for shopping experience, food choice and possibly adverse health outcomes. The aim of this study was to examine consumer attitudes and evaluate sales effects of a healthy checkout supermarket intervention. The study was part of Project Sundhed & Lokalsamfund (Project SoL); a Danish participatory community-based health promotion intervention. Consumer attitudes towards unhealthy snack exposure in supermarkets were examined in a qualitative pre-intervention study (29 short in-store interviews, 11 semi-structured interviews and three focus group interviews). Findings were presented to food retailers and informed the decision to test a healthy checkout intervention. Sugar confectionery at one checkout counter was substituted with fruit and healthy snacking items in four stores for 4 weeks. The intervention was evaluated by 48 short exit interviews on consumer perceptions of the intervention and by linear mixed model analyses of supermarket sales data from the intervention area and a matched control area. The qualitative pre-intervention study identified consumer concern and annoyance with placement and promotion of unhealthy snacks in local stores. Store managers were willing to respond to local consumer concern and a healthy checkout intervention was therefore implemented. Exit interviews found positive attitudes towards the intervention, while intervention awareness was modest. Most participants believed that the intervention could help other consumers make healthier choices, while fewer expected to be influenced by the intervention themselves. Statistical analyses suggested an intervention effect on sales of carrot snack packs when compared with sales before the intervention in Bornholm control stores (P branding opportunity for supermarkets, thus representing a win-win strategy for store managers and consumers in the short term. However, the intervention
Veling, Harm; Chen, Zhang; Tombrock, Merel C; Verpaalen, Iris A M; Schmitz, Laura I; Dijksterhuis, Ap; Holland, Rob W
Many people find it hard to change their dietary choices. Food choice often occurs impulsively, without deliberation, and it has been unclear whether impulsive food choice can be experimentally created. Across 3 exploratory and 2 confirmatory preregistered experiments we examined whether impulsive food choice can be trained. Participants were cued to make motor responses upon the presentation of, among others, healthy and sustainable food items. They subsequently selected these food items more often for actual consumption when they needed to make their choices impulsively as a result of time pressure. This effect disappeared when participants were asked to think about their choices, merely received more time to make their choices, or when choosing required attention to alternatives. Participants preferred high to low valued food items under time pressure and without time pressure, suggesting that the impulsive choices reflect valid preferences. These findings demonstrate that it is possible to train impulsive choices for food items while leaving deliberative choices for these items unaffected, and connect research on attention training to dual-process theories of decision making. The present research suggests that attention training may lead to behavioral change only when people behave impulsively. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Substituting sugar confectionery with fruit and healthy snacks at checkout – a win-win strategy for consumers and food stores? a study on consumer attitudes and sales effects of a healthy supermarket intervention
Lise L. Winkler
Full Text Available Abstract Background The widespread use of in-store marketing strategies to induce unhealthy impulsive purchases has implications for shopping experience, food choice and possibly adverse health outcomes. The aim of this study was to examine consumer attitudes and evaluate sales effects of a healthy checkout supermarket intervention. The study was part of Project Sundhed & Lokalsamfund (Project SoL; a Danish participatory community-based health promotion intervention. Methods Consumer attitudes towards unhealthy snack exposure in supermarkets were examined in a qualitative pre-intervention study (29 short in-store interviews, 11 semi-structured interviews and three focus group interviews. Findings were presented to food retailers and informed the decision to test a healthy checkout intervention. Sugar confectionery at one checkout counter was substituted with fruit and healthy snacking items in four stores for 4 weeks. The intervention was evaluated by 48 short exit interviews on consumer perceptions of the intervention and by linear mixed model analyses of supermarket sales data from the intervention area and a matched control area. Results The qualitative pre-intervention study identified consumer concern and annoyance with placement and promotion of unhealthy snacks in local stores. Store managers were willing to respond to local consumer concern and a healthy checkout intervention was therefore implemented. Exit interviews found positive attitudes towards the intervention, while intervention awareness was modest. Most participants believed that the intervention could help other consumers make healthier choices, while fewer expected to be influenced by the intervention themselves. Statistical analyses suggested an intervention effect on sales of carrot snack packs when compared with sales before the intervention in Bornholm control stores (P < 0.05. No significant intervention effect on sales of other intervention items or sugar
Bingham Clarissa ML
Full Text Available Abstract Background In Finland, all men are liable to military service and a clear majority completes service. The increasing prevalence of obesity also among soldiers concerns conscripts’ food choices. Conscripts are served nutritionally planned regular main meals but individual choices take place in free-time eating. This study assesses the effects in conscripts’ eating habits in an intervention targeting the supply of healthy foods available in the military setting. Methods Participants were 604 18-21-year old male conscripts of whom 242 belonged to Control Group and 362 to Intervention Group. Participants of Control Group were historical controls performing military service one year before Intervention Group. The intervention targeted selection, placement, and attractiveness of healthy foods in garrison refectories and soldier’s home cafeterias, the two main food providers in the military. Dietary intake data was collected by self-administered questionnaire at three time points: before/beginning of military service (T0, 8 weeks (T1 and 6 months (T2 of military service. Outcome measures were food consumption frequencies and four dietary indexes (Cereal Index, Fruit and Vegetable Index, Fat Index and Sugar Index developed to characterize the diet. Changes between study groups in outcome variables and in time were analysed by repeated-measures analysis of covariance. Results Significant (p Conclusions In the military setting, healthier food choices can be promoted by intervening on the main food environments by improving the supply of healthy foods. However, impacting on conscripts’ individual selection as fruit and vegetable consumption is more challenging.
Full Text Available With growing evidence for the positive health outcomes associated with a plant-based diet, the study’s purpose was to examine the potential of shifting adolescents’ food choices towards plant-based foods. Using a real world setting of a school canteen, a set of small changes to the choice architecture was designed and deployed in a secondary school in Yorkshire, England. Focussing on designated food items (whole fruit, fruit salad, vegetarian daily specials, and sandwiches containing salad the changes were implemented for six weeks. Data collected on students’ food choice (218,796 transactions enabled students’ (980 students selections to be examined. Students’ food choice was compared for three periods: baseline (29 weeks; intervention (six weeks; and post-intervention (three weeks. Selection of designated food items significantly increased during the intervention and post-intervention periods, compared to baseline (baseline, 1.4%; intervention 3.0%; post-intervention, 2.2% χ2(2 = 68.1, p < 0.001. Logistic regression modelling also revealed the independent effect of the intervention, with students 2.5 times as likely (p < 0.001 to select the designated food items during the intervention period, compared to baseline. The study’s results point to the influence of choice architecture within secondary school settings, and its potential role in improving adolescents’ daily food choices.
... Protein 15g Total Amounts To make heart-healthy food choices, look at the totals and cut back on • ... Toolkit No. 8: Protect Your Heart: Make Smart Food Choices • Toolkit No. 9: Protect Your Heart: Choose Fats ...
Marcum, Christopher Steven; Goldring, Megan R; McBride, Colleen M; Persky, Susan
Meal construction is largely governed by nonconscious and habit-based processes that can be represented as a collection of in dividual, micro-level food choices that eventually give rise to a final plate. Despite this, dietary behavior intervention research rarely captures these micro-level food choice processes, instead measuring outcomes at aggregated levels. This is due in part to a dearth of analytic techniques to model these dynamic time-series events. The current article addresses this limitation by applying a generalization of the relational event framework to model micro-level food choice behavior following an educational intervention. Relational event modeling was used to model the food choices that 221 mothers made for their child following receipt of an information-based intervention. Participants were randomized to receive either (a) control information; (b) childhood obesity risk information; (c) childhood obesity risk information plus a personalized family history-based risk estimate for their child. Participants then made food choices for their child in a virtual reality-based food buffet simulation. Micro-level aspects of the built environment, such as the ordering of each food in the buffet, were influential. Other dynamic processes such as choice inertia also influenced food selection. Among participants receiving the strongest intervention condition, choice inertia decreased and the overall rate of food selection increased. Modeling food selection processes can elucidate the points at which interventions exert their influence. Researchers can leverage these findings to gain insight into nonconscious and uncontrollable aspects of food selection that influence dietary outcomes, which can ultimately improve the design of dietary interventions.
Mötteli, Sonja; Keller, Carmen; Siegrist, Michael; Barbey, Jana; Bucher, Tamara
Little is known about laypeople's practical understanding of a healthy diet, although this is important to successfully promote healthy eating. The present study is the first to experimentally examine how consumers define healthy and balanced food choices for an entire day compared with normal choices and compared with dietary guidelines. We used an extensive fake food buffet (FFB) with 179 foods commonly consumed in the Swiss diet. The FFB is a validated method to investigate food choice behaviour in a well-controlled laboratory setting. People from the general population in Switzerland (n 187; 51·9 % females), aged between 18 and 65 years, were randomly assigned to one of two conditions. In the control group, the participants were instructed to serve themselves foods they would eat on a normal day, whereas in the 'healthy' group they were instructed to choose foods representing a healthy diet. Participants chose significantly more healthy foods, with 4·5 g more dietary fibre, 2 % more protein and 2 % less SFA in the 'healthy' group compared with the control group. However, in both experimental conditions, participants served themselves foods containing twice as much sugar and salt than recommended by dietary guidelines. The results suggest that laypeople lack knowledge about the recommended portion sizes and the amounts of critical nutrients in processed food, which has important implications for communicating dietary guidelines. Furthermore, the energy of the food served was substantially correlated with the energy needs of the participants, demonstrating the potential of the fake food buffet method.
Adedokun, Omolola A; Plonski, Paula; Jenkins-Howard, Brooke; Cotterill, Debra B; Vail, Ann
To evaluate the impact of the University of Kentucky's Healthy Choices for Every Body (HCEB) adult nutrition education curriculum on participants' food resource management (FRM) skills and food safety practices. A quasi-experimental design was employed using propensity score matching to pair 8 intervention counties with 8 comparison counties. Independent-samples t tests and ANCOVA models compared gains in FRM skills and food safety practices between the intervention and comparison groups (n = 413 and 113, respectively). Propensity score matching analysis showed a statistical balance and similarities between the comparison and intervention groups. Food resource management and food safety gain scores were statistically significantly higher for the intervention group (P food safety practices of participants. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Sarah J. Hardcastle
Full Text Available In this Special Issue, entitled “Food choice and Nutrition: A Social Psychological Perspective”, three broad themes have been identified: (1 social and environmental influences on food choice; (2 psychological influences on eating behaviour; and (3 eating behaviour profiling. The studies that addressed the social and environmental influences indicated that further research would do well to promote positive food choices rather than reduce negative food choices; promote the reading and interpretation of food labels and find ways to effectively market healthy food choices through accessibility, availability and presentation. The studies on psychological influences found that intentions, perceived behavioural control, and confidence were predictors of healthy eating. Given the importance of psychological factors, such as perceived behavioural control and self-efficacy, healthy eating interventions should reduce barriers to healthy eating and foster perceptions of confidence to consume a healthy diet. The final theme focused on the clustering of individuals according to eating behaviour. Some “types” of individuals reported more frequent consumption of fast foods, ready meals or convenience meals or greater levels of disinhibition and less control over food cravings. Intervention designs which make use of multi-level strategies as advocated by the Ecological Model of Behaviour change that proposes multi-level (combining psychological, social and environmental strategies are likely to be more effective in reaching and engaging individuals susceptible to unhealthy eating habits than interventions operating on a single level.
Salmon, S.J.; Fennis, B.M.; Ridder, D.T.D.; Adriaanse, M.A.; de Vet, E.
Objective: Food choices are often made mindlessly, when individuals are not able or willing to exert self-control. Under low self-control, individuals have difficulties to resist palatable but unhealthy food products. In contrast to previous research aiming to foster healthy choices by promoting
Salmon, S.J.; Fennis, B.M.; Ridder, de D.T.D.; Adriaanse, M.A.; Vet, de E.
OBJECTIVE: Food choices are often made mindlessly, when individuals are not able or willing to exert self-control. Under low self-control, individuals have difficulties to resist palatable but unhealthy food products. In contrast to previous research aiming to foster healthy choices by promoting
de Ridder, Denise; Kroese, Floor; Evers, Catharine; Adriaanse, Marieke; Gillebaart, Marleen
To discuss healthy diet from a psychological perspective by considering definitions of healthy diet in terms of consumer understanding; the health effects of specific dietary elements in terms of overweight and (chronic) illness; the prevalence of healthy diet; the psychological and environmental determinants of healthy diet; and the psychological interventions that have been designed to promote healthy diet. A systematic review of the psychological literature on healthy diet. Our findings suggest that consumers have a relatively poor understanding of a healthy diet. The literature also demonstrates that there is poor evidence on the health protective effects of single foods or nutrients. We further show that low SES is the single consistent risk factor for not adhering to a healthy diet. Our review of the literature on determinants demonstrates that intentions, habits, self-regulatory skills, and the social and physical environment are the most important determinants of a healthy diet, which are in turn amenable to change by intervention strategies with varying levels of effectiveness. Educational interventions generally show a limited effect on practising a healthy diet whereas interventions targeting habitual behaviour and/or the physical environment seem more promising. In view of the large number of people who are concerned about their diets and make attempts to change their dietary patterns, we conclude that it is crucial to gain a better understanding of both the automatic and environmental influences that are responsible for people not acting upon their good intentions for diet change.
Kroese, Floor M; Marchiori, David R; de Ridder, Denise T D
BACKGROUND: Recognizing the mindless nature of many food decisions, it has been suggested that attempts to increase healthy eating should not focus on convincing people what is 'right' but rather aim to adjust the environment such that people are automatically directed toward healthy choices. This
Kroese, Floor M; Marchiori, David R; de Ridder, Denise T D
Recognizing the mindless nature of many food decisions, it has been suggested that attempts to increase healthy eating should not focus on convincing people what is 'right' but rather aim to adjust the environment such that people are automatically directed toward healthy choices. This study investigated a nudge aiming to promote healthy food choices in train station snack shops. The nudge involved a repositioning of food products: healthy foods were placed at the cash register desk, while keeping unhealthy products available elsewhere in the shop. Three snack shops were included: a control condition; a nudge condition repositioning healthy products and a nudge + disclosure condition employing the same nudge together with an explanatory sign. Next to examining its effectiveness during 1 week, the study assessed customers' acceptance of the nudge. Controlling for a baseline week, more healthy (but not fewer unhealthy) products were sold in both nudge conditions, with no difference between the nudge and the nudge + disclosure condition. A majority of customers reported positive attitudes toward the nudge. Repositioning healthy foods is a simple, effective and well-accepted nudge to increase healthy purchases. Moreover, disclosing its purpose does not impact on effectiveness. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Sonnenberg, Lillian; Gelsomin, Emily; Levy, Douglas E; Riis, Jason; Barraclough, Susan; Thorndike, Anne N
We surveyed customers in a hospital cafeteria in Boston, Massachusetts before and after implementation of traffic light food labeling to determine the effect of labels on customers' awareness and purchase of healthy foods. Cafeteria items were identified as red (unhealthy), yellow (less healthy), or green (healthy). Customers were interviewed before (N=166) and after (N=223) labeling was implemented. Each respondent was linked to cash register data to determine the proportion of red, yellow, and green items purchased. Data were collected from February-April 2010. We compared responses to survey questions and mean proportion of red, yellow, and green items per transaction between customers interviewed during baseline and customers interviewed during the intervention. Survey response rate was 60%. Comparing responses during labeling intervention to baseline, more respondents identified health/nutrition as an important factor in their purchase (61% vs. 46%, p=0.004) and reported looking at nutrition information (33% vs. 15%, ppurchases were more likely to purchase healthier items than respondents who did not notice labels (ppoint-of-purchase. © 2013.
Levy, Douglas E.; Riis, Jason; Sonnenberg, Lillian M.; Barraclough, Susan J.; Thorndike, Anne N.
Background Effective strategies are needed to address obesity, particularly among minority and low-income individuals. Purpose To test whether a two-phase point-of-purchase intervention improved food choices across racial, socioeconomic (job type) groups. Design A 9-month longitudinal study from 2009 to 2010 assessing person-level changes in purchases of healthy and unhealthy foods following sequentially introduced interventions. Data were analyzed in 2011. Setting/participants Participants were 4642 employees of a large hospital in Boston MA who were regular cafeteria patrons. Interventions The first intervention was a traffic light–style color-coded labeling system encouraging patrons to purchase healthy items (labeled green) and avoid unhealthy items (labeled red). The second intervention manipulated “choice architecture” by physically rearranging certain cafeteria items, making green-labeled items more accessible, red-labeled items less accessible. Main outcome measures Proportion of green- (or red-) labeled items purchased by an employee. Subanalyses tracked beverage purchases, including calories and price per beverage. Results Employees self-identified as white (73%), black (10%), Latino (7%), and Asian (10%). Compared to white employees, Latino and black employees purchased a higher proportion of red items at baseline (18%, 28%, and 33%, respectively, p0.05 for interaction between race or job type and intervention). Mean calories per beverage decreased similarly over the study period for all racial groups and job types, with no increase in per-beverage spending. Conclusions Despite baseline differences in healthy food purchases, a simple color-coded labeling and choice architecture intervention improved food and beverage choices among employees from all racial and socioeconomic backgrounds. PMID:22898116
Jayne, Julianna M; Frongillo, Edward A; Torres-McGehee, Toni M; Emerson, Dawn M; Glover, Saundra H; Blake, Christine E
Promoting healthy eating among Soldiers is a priority to the Army due to the link between nutrition and performance. The Army typically uses nutrition education to encourage Soldiers to make healthier food choices with low emphasis on other psychosocial determinants of food choice behaviors. Drill Sergeant Candidates (n = 575) completed surveys assessing nutrition knowledge, eating identity type, and food choice behaviors including fruit and vegetable intake, skipping meals, and eating out frequency. In multiple linear regression models using full-information maximum likelihood estimation while controlling for race/ethnicity, education, and marital status, we examined relationships between nutrition knowledge, a healthy eating identity, and Soldiers' food choice behaviors. The study was approved by the Department of Defense and University of South Carolina's Institutional Review Boards. A healthy eating identity was positively associated with greater fruit and vegetable consumption (p eating out frequency (p healthy eating identity may be more effective for promoting healthy food choice behaviors than nutrition education alone. Determining if various points in a Soldier's career could be leveraged to influence a healthy eating identity and behaviors could be an important strategy to improve compliance with health promotion programs.
Heard, Amy M; Harris, Jennifer L; Liu, Sai; Schwartz, Marlene B; Li, Xun
Public health interventions must address poor diet among U.S. children, but research is needed to better understand factors influencing children's food choices. Using an online grocery store simulation, this research piloted a novel method to assess children's snack selection in a controlled but naturalistic laboratory setting, evaluate predictors of choice, and experimentally test whether promotions on food packages altered choices. Children (7-12 years, N = 61) were randomly assigned to one of three conditions: promotions on healthy products; promotions on unhealthy products; and no promotions (control). They selected from a variety of healthy and unhealthy foods and beverages and rated all products on healthfulness and taste. Promotions on food packaging did not affect snack selection in this study, but findings supported our other hypothesis that perceived taste would be the strongest predictor of food choice. Children accurately rated product healthfulness, but these ratings did not predict healthy snack choices or taste ratings for healthy or unhealthy snacks. These results suggest that interventions to improve children's food choices should focus on increasing availability of healthy options and identifying opportunities to enhance children's liking of healthy options. However, nutrition education alone is unlikely to improve children's diets. Further testing is required, but the simulated online grocery store method shows potential for measuring children's food choices. Copyright © 2015 Elsevier Ltd. All rights reserved.
Wahl, Deborah R; Villinger, Karoline; König, Laura M; Ziesemer, Katrin; Schupp, Harald T; Renner, Britta
Research suggests that "healthy" food choices such as eating fruits and vegetables have not only physical but also mental health benefits and might be a long-term investment in future well-being. This view contrasts with the belief that high-caloric foods taste better, make us happy, and alleviate a negative mood. To provide a more comprehensive assessment of food choice and well-being, we investigated in-the-moment eating happiness by assessing complete, real life dietary behaviour across eight days using smartphone-based ecological momentary assessment. Three main findings emerged: First, of 14 different main food categories, vegetables consumption contributed the largest share to eating happiness measured across eight days. Second, sweets on average provided comparable induced eating happiness to "healthy" food choices such as fruits or vegetables. Third, dinner elicited comparable eating happiness to snacking. These findings are discussed within the "food as health" and "food as well-being" perspectives on eating behaviour.
Levesque, Deborah A; Johnson, Janet L; Welch, Carol A; Prochaska, Janice M; Paiva, Andrea L
Teen dating violence is a serious public health problem. A cluster-randomized trial was conducted to assess the efficacy of Teen Choices , a 3-session online program that delivers assessments and individualized guidance matched to dating history, dating violence experiences, and stage of readiness for using healthy relationship skills. For high risk victims of dating violence, the program addresses readiness to keep oneself safe in relationships. Twenty high schools were randomly assigned to the Teen Choices condition ( n =2,000) or a Comparison condition ( n =1,901). Emotional and physical dating violence victimization and perpetration were assessed at 6 and 12 months in the subset of participants (total n =2,605) who reported a past-year history of dating violence at baseline, and/or who dated during the study. The Teen Choices program was associated with significantly reduced odds of all four types of dating violence (adjusted ORs ranging from .45 to .63 at 12 months follow-up). For three of the four violence outcomes, participants with a past-year history of that type of violence benefited significantly more from the intervention than students without a past-year history. The Teen Choices program provides an effective and practicable strategy for intervention for teen dating violence prevention.
Renzaho, Andre M N; Halliday, Jennifer A; Mellor, David; Green, Julie
Although obesity among immigrants remains an important area of study given the increasing migrant population in Australia and other developed countries, research on factors amenable to intervention is sparse. The aim of the study was to develop a culturally-competent obesity prevention program for sub-Saharan African (SSA) families with children aged 12-17 years using a community-partnered participatory approach. A community-partnered participatory approach that allowed the intervention to be developed in collaborative partnership with communities was used. Three pilot studies were carried out in 2008 and 2009 which included focus groups, interviews, and workshops with SSA parents, teenagers and health professionals, and emerging themes were used to inform the intervention content. A cultural competence framework containing 10 strategies was developed to inform the development of the program. Using findings from our scoping research, together with community consultations through the African Review Panel, a draft program outline (skeleton) was developed and presented in two separate community forums with SSA community members and health professionals working with SSA communities in Melbourne. The 'Healthy Migrant Families Initiative (HMFI): Challenges and Choices' program was developed and designed to assist African families in their transition to life in a new country. The program consists of nine sessions, each approximately 1 1/2 hours in length, which are divided into two modules based on the topic. The first module 'Healthy lifestyles in a new culture' (5 sessions) focuses on healthy eating, active living and healthy body weight. The second module 'Healthy families in a new culture' (4 sessions) focuses on parenting, communication and problem solving. The sessions are designed for a group setting (6-12 people per group), as many of the program activities are discussion-based, supported by session materials and program resources. Strong partnerships and
Keith, Jill F; Stastny, Sherri; Brunt, Ardith; Agnew, Wanda
American Indian and Alaskan Native individuals experience disproportionate levels of chronic health conditions such as type 2 diabetes and overweight and obesity that are influenced by dietary patterns and food choices. Understanding factors that influence healthy food choices among tribal college students can enrich education and programs that target dietary intake. To build an understanding of factors that influence healthy food choices among tribal college students at increased risk for college attrition. A nonexperimental cohort design was used for qualitative descriptive analysis. Participants (N=20) were purposively sampled, newly enrolled, academically underprepared tribal college students enrolled in a culturally relevant life skills course at an upper Midwest tribal college between September 2013 and May 2015. Participant demographic characteristics included various tribal affiliations, ages, and number of dependents. Participant responses to qualitative research questions about dietary intake, food choices, self-efficacy for healthy food choices, psychosocial determinants, and barriers to healthy food choices during telephone interviews were used as measures. Qualitative analysis included prestudy identification of researcher bias/assumptions, audiorecording and transcription, initial analysis (coding), secondary analysis (sorting and identifying meaning), and verification (comparative pattern analysis). Qualitative analysis revealed a variety of themes and subthemes about healthy food choices. Main themes related to barriers included taste, food gathering and preparation, and difficulty clarifying healthy food choices. Main themes related to strategies included taste, cultural traditions and practices, and personal motivation factors. Qualitative analysis identified barrier and strategy themes that may assist nutrition and dietetics practitioners working with tribal/indigenous communities, tribal college educators and health specialists, and tribal
Mroczek, Daniel K.
This commentary on the special section on conscientiousness and healthy aging focuses on several topics brought up in this collection of articles. One is the promise of personality interventions. Despite skepticism on the part of some, such interventions may ultimately prove successful. This is in part because of similarities between personality…
Fenko, Anna; Nicolaas, Iris; Galetzka, Mirjam
Visual attention to health labels can indicate a subsequent healthy food choice. This study looked into the relative effects of Choices logos and traffic light labels on consumers’ visual attention and food choice. A field experiment using mobile eye-tracking was conducted in a Dutch university
Burns, Rachel J; Rothman, Alexander J
Providing a variety of food generally increases consumption and enjoyment. This effect is typically associated with unhealthy behavior (e.g., overindulgence at a buffet) and studied during a single meal. Two studies tested whether this effect can be leveraged in a subtle, simple manipulation to promote healthy food choices over the course of a day. In Studies 1 and 2, 188 and 187 participants, respectively, chose between a sweet and a piece of fruit in the afternoon. The fruit was either the same as or different from fruit that was selected in the morning; choice was not given in the morning. Study 1 tested this effect in the domain of expressed preferences and Study 2 examined actual choice. In both studies, a second piece of fruit was more likely to be selected in the afternoon if it was different from fruit that was selected in the morning. These results illustrate how a robust effect that is typically associated with unhealthy outcomes can be harnessed to promote healthy food choices and underscore the importance of conceptualizing eating as a series of interrelated behavioral decisions. This work has implications for applied settings, such as cafeterias, and is distinguished from other simple structural manipulations by its focus on sustaining healthy food choice over the course of the day. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Hansen, Pelle Guldborg; Skov, Laurits Rohden; Skov, Katrine Lund
In recent years, the nudge approach to behavior change has emerged from the behavioral sciences to challenge the traditional use of regulation in public health strategies to address modifiable individual-level behaviors related to the rise of noncommunicable diseases and their treatment. However, integration and testing of the nudge approach as part of more comprehensive public health strategies aimed at making healthy choices easier are being threatened by inadequate understandings of its scientific character, its relationship with regulation, and its ethical implications. This article reviews this character and its ethical implication with a special emphasis on the compatibility of nudging with traditional regulation, special domains of experience, and the need for a more nuanced approach to the ethical debate. The aim is to advance readers' understanding and give guidance to those who have considered working with or incorporating the nudge approach into programs or policies aimed at making healthful choices easier.
van Buul, Vincent J; Bolman, Catherine A W; Brouns, Fred J P H; Lechner, Lilian
People are increasingly aware of the positive effects of a healthy diet. Concurrently, daily food consumption decisions - choices about both the quality and quantity of food that is ingested - are steered more by what consumers consider healthy. Despite the increased aim to eat healthier, however, consumers often do not read or incorrectly interpret on-pack nutrition information, resulting in suboptimal food choices in terms of health. This study aims to unravel the determinants of such inadvertent food choices from these consumers. In an online process-tracking study, we measured the actual usage of available back-of-pack nutrition information during substitutive food choices made by 240 participants who had the intention to eat healthy. Using mouse-tracking software in a computerized task in which participants had to make dichotomous food choices (e.g., coconut oil or olive oil for baking), we measured the frequency and time of nutritional information considered. Combined with demographic and psychosocial data, including information on the level of intention, action planning, self-efficacy, and nutrition literacy, we were able to model the determinants of inadvertent unhealthy substitutive food choices in a sequential multiple regression (R 2 = 0.40). In these consumers who intended to eat healthy, the quantity of obtained nutrition information significantly contributed as an associative factor of the percentage of healthy food choices made. Moreover, the level of correct answers in a nutrition literacy test, as well as taste preferences, significantly predicted the percentage of healthier choices. We discuss that common psychosocial determinants of healthy behavior, such as intention, action planning, and self-efficacy, need to be augmented with a person's actual reading and understanding of nutrition information to better explain the variance in healthy food choice behavior. Copyright © 2017 Elsevier Ltd. All rights reserved.
Pechey, Rachel; Monsivais, Pablo
Investigations of the contribution of food costs to socioeconomic inequalities in diet quality may have been limited by the use of estimated (vs. actual) food expenditures, not accounting for where individuals shop, and possible reverse mediation between food expenditures and healthiness of food choices. This study aimed to explore the extent to which food expenditure mediates socioeconomic inequalities in the healthiness of household food choices. Observational panel data on take-home food a...
Grubliauskiene, Aiste; Verhoeven, Maxime; Dewitte, Siegfried
This study investigated how a combination of tangible and non-tangible rewards can alter health-related decisions made by children. Children chose between an unhealthy food option (a bowl of potato crisps) and a healthy food option (a bowl of grapes) on two occasions. In the first round, we manipulated the expected tangible reward and praise. The tangible reward was manipulated by means of a game that the child received upon choosing the healthy product, and the praise was manipulated by means of the teacher's applause and smiles if the child selected the healthy option. The second trial occurred three days after the first trial using the same food item options. Neither tangible rewards nor praise influenced the children's choices by themselves, but combining the two substantially increased the children's likelihood of selecting the healthy food choice. The data were consistent with a reattribution process akin to social labelling. Although initially externally motivated to select the healthy option, the children who received praise appeared to interpret their choice as internally motivated and therefore continued to select the healthy option even in the absence of reward. Copyright © 2012 Elsevier Ltd. All rights reserved.
Volpe, Roberto; Stefano, Predieri; Massimiliano, Magli; Francesca, Martelli; Gianluca, Sotis; Federica, Rossi
An educational activity, aimed at highlighting the benefits of Mediterranean Diet, compared to less healthy eating patterns, can encourage the adoption and maintenance of a mindful approach to food choice. This is especially important when a progressive shift towards a non-Mediterranean dietary pattern can be observed, even in Mediterranean countries. To test a protocol aimed at increasing knowledge and motivation to embrace healthy eating habits and, engendering conscientious food choices, improve the prevention of non-communicable diseases. Employees were involved in educational activities focusing on a healthy Mediterranean diet and on the role played by extra-virgin olive oil, one of its key components. Food questionnaires were completed both before and after the educational and information activities, in order to assess changes in personal knowledge of and attitudes towards fat consumption. Answers on dietary guidelines and fat properties were more accurate after the seminars. The results showed increased understanding of the properties of extra-virgin olive oil versus seed oil and a stronger tendency towards healthy food choices. Implementing preventive information and training strategies and tools in the workplace, can motivate a more mindful approach to food choice with the long-term goal of contribute to reducing non-communicable diseases.
Hardcastle, Sarah J; Blake, Nicola
The purpose of this qualitative study was to explore the perceptions and attitudes that underlie food choices, and, the impact of a school-based healthy eating intervention in mothers from an economically-disadvantaged community. The aim of the intervention was to educate children to act as 'health messengers' to their families. Sixteen semi-structured phone interviews were conducted with mothers with four receiving a second interview. Interviews were conducted following their child's participation in a six-week after school healthy cooking intervention. Thematic content analysis revealed four main themes: Cost and budget influence on food choices, diversity in household rules controlling food, role of socialisation on diet, and improved cooking skills and confidence to make homemade meals. The interview findings demonstrated the positive influence of the after-school cooking intervention on children and their families in cooking skills, promoting healthier cooking methods and increasing confidence to prepare homemade meals. The findings demonstrated the wider economic and social influences on food choices and eating practices. Socialisation into, and strong cultural norms around, eating habits were significant influences on family diet and on parental decisions underpinning food choices and attitudes towards the control of food within the family. The intervention was perceived to be successful in terms of improving nutritional knowledge, cooking skills and increasing confidence to make healthy and tasty homemade meals. The study demonstrates the importance of parental involvement in school-based interventions if improvements in healthy eating are to be evidenced at the family level and maintained. Copyright © 2015 Elsevier Ltd. All rights reserved.
Wahl, Deborah R.; Villinger, Karoline; König, Laura M.; Ziesemer, Katrin; Schupp, Harald T.; Renner, Britta
Research suggests that "healthy" food choices such as eating fruits and vegetables have not only physical but also mental health benefits and might be a long-term investment in future well-being. This view contrasts with the belief that high-caloric foods taste better, make us happy, and alleviate a negative mood. To provide a more comprehensive assessment of food choice and well-being, we investigated in-the-moment eating happiness by assessing complete, real life dietary behaviour across ei...
Wang, H. Echo; Lee, Matthew; Hart, Adante; Summers, Amber C.; Steeves, Elizabeth Anderson; Gittelsohn, Joel
Soaring obesity rates in the United States demand comprehensive health intervention strategies that simultaneously address dietary patterns, physical activity, psychosocial factors and the food environment. Healthy Bodies, Healthy Souls (HBHS) is a church-based, community-participatory, cluster-randomized health intervention trial conducted in…
Aceves-Martins, Magaly; Llauradó, Elisabet; Tarro, Lucia; Moriña, David; Papell-Garcia, Ignasi; Prades-Tena, Jordi; Kettner-Høeberg, Helle; Puiggròs, Francesc; Arola, Lluís; Davies, Amy; Giralt, Montse; Solà, Rosa
Encouraging adolescents to adopt healthy lifestyles can be challenging. The aim of the "Som la Pera" study was to engage adolescents by applying new strategies to increase both their fruit and vegetable consumption and their physical activity (PA) while reducing their sedentary behavior. In disadvantaged neighborhoods of Reus (Spain), two high schools were randomly assigned to the intervention (n = 170 adolescents 13- to 16-year-olds) and two were assigned to the control group (n = 223 adolescents 13- to 16-year-olds). The intervention, which lasted 12 months and spanned 2 academic years (2013-2015), used social marketing (SM) to improve healthy choices. The peer-led strategy involved 5 adolescents who designed and implemented 10 activities as challenges for their 165 school-aged peers. The control group received no intervention. To assess self-reported lifestyles in both groups, the Health Behavior in School-Aged Children Survey was used at baseline and end of study. After 12 months, intervention adolescents showed an increase of 28.9% in ≥1 fruit/day (p < 0.01) and of 18.5% in ≥6 hours/week of PA (p < 0.01) compared with controls. Additionally, intervention group males had an increase of 28.8% in ≥1 vegetable/day (p < 0.01) and of 15.6% in ≤2 hours/day of sedentary activity (p = 0.01) compared with controls. A school-based, peer-led, SM intervention developed by adolescents attending high schools in low-income neighborhoods effectively improved the healthy choices of their school-aged peers, leading to increased fruit consumption and PA in adolescents of both genders. Furthermore, adolescent males were more sensitive to improvements in healthy choices, showing increased vegetable consumption and decreased sedentary behavior.
Williams, Lauren K; Abbott, Gavin; Thornton, Lukar E; Worsley, Anthony; Ball, Kylie; Crawford, David
Despite strong empirical support for the association between perceived food affordability and dietary intake amongst families with a lower socioeconomic position (SEP), there is limited evidence of the most effective strategies for promoting more positive perceptions of healthy food affordability among this group. This paper reports findings from a pilot intervention that aimed to improve perceptions of healthy food affordability amongst mothers. Participants were 66 mothers who were the parents of children recruited from primary schools located in socioeconomically disadvantaged suburbs. Intervention group participants viewed a slideshow focussed on healthy snack food affordability that illustrated cheaper healthier alternatives to common snack foods as well as food budgeting tips and price comparison education. A mixed between-within ANCOVA was conducted to examine group differences in perceived affordability of healthy food across three time points. Results revealed no difference in perceived affordability of healthy food between the two groups at baseline whereas at post-intervention and follow-up, mothers in the intervention group perceived healthy food as more affordable than the control group. Focussing on education-based interventions to improve perceptions of healthy food affordability may be a promising approach that complements existing nutrition promotion strategies.
Weibel, Christian; Messner, Claude; Brügger, Adrian
Based on the self-licensing literature and goal theory, we expected and found that completed (im)moral actions lead to markedly different food choices (Studies 1 & 2) than intended (im)moral actions (Study 2). In Study 1, people more often chose healthy over unhealthy food options when they recalled a completed egoistic action than when they recalled a completed altruistic action. Study 2 confirmed this finding and furthermore showed that the self-licensing effect in food choices is moderated by the action stage (completed versus intended) of the moral or immoral action. This article extends the existing self-licensing literature and opens up new perspectives for changing consumers' food consumption behavior. Copyright © 2014 Elsevier Ltd. All rights reserved.
Primavesi, Laura; Caccavelli, Giovanna; Ciliberto, Alessandra; Pauze, Emmanuel
Promotion of healthy eating can no longer be postponed as a priority, given the alarming growth rate of chronic degenerative diseases in Western countries. We elaborated a nutrieconomic model to assess and identify the most nutritious and affordable food choices. Seventy-one food items representing the main food categories were included and their nationally representative prices monitored. Food composition was determined using CRA-NUT (Centro di Ricerca per gli Alimenti e la Nutrizione) and IEO (Istituto Europeo di Oncologia) databases. To define food nutritional quality, the mean adequacy ratio and mean excess ratio were combined. Both prices and nutritional quality were normalised for the edible food content and for the recommended serving sizes for the Italian adult population. Stores located in different provinces throughout Italy. Not applicable. Cereals and legumes presented very similar nutritional qualities and prices per serving. Seasonal fruits and vegetables presented differentiated nutritional qualities and almost equal prices. Products of animal origin showed similar nutritional qualities and varied prices: the best nutrieconomic choices were milk, oily fish and poultry for the dairy products, fish and meat groups, respectively. Analysing two balanced weekly menus, our nutrieconomic model was able to note a significant decrease in cost of approximately 30 % by varying animal-protein sources without affecting nutritional quality. Healthy eating does not necessarily imply spending large amounts of money but rather being able to make nutritionally optimal choices. The nutrieconomic model is an innovative and practical way to help consumers make correct food choices and nutritionists increase the compliance of their patients.
King, Lorraine; Hill, Andrew J
The marketing of foods to children has been criticised by parents and academics alike and the control of such advertising is being considered by politicians. Much of the current research focuses on TV advertising. This study aimed to investigate the effects of exposure to printed advertisements for healthy, less healthy and non-food products on children's mood, hunger, food choice and product recall. Accordingly, 309 children (mean age 9.7 years) received booklets in a quasi-random order. Each booklet contained one of the three types of adverts, ratings of current self-perception and a food choice measure. The booklets were presented as a school-based media literacy exercise. Body weight, height and body satisfaction were assessed 1 week later. The three groups did not differ in the effect on current state or end of session food choice. However, children recalled more of the less healthy food products, even when accounting for recent exposure. Greater product recall of less healthy foods is relevant to future consumption but has a number of possible interpretations. The further exploration of non-TV food marketing is warranted at a time when marketing through these channels is increasing, not least as a result of greater TV advertising regulations.
Robinson, Eric; Higgs, Suzanne
Eating with others has been shown to influence the amount of food eaten in a meal or snack. We examined whether choosing food in the presence of another person who is choosing either predominantly low-energy-dense or high-energy-dense foods affects food choices. A between-subjects laboratory-based study was used. A group of 100 young females selected a lunch-time meal from a buffet consisting of a range of high-energy-dense and low-energy-dense foods, in the presence of an 'unhealthy' eating partner (who chose predominantly high-energy-dense foods) or a 'healthy' eating partner (who chose predominantly low-energy-dense foods) or when alone. Participants in the 'unhealthy' eating partner condition were significantly less likely to choose and consume a low-energy-dense food item (carrots), than when choosing alone or in the presence of a 'healthy' eater. Choice of high-energy-dense food did not differ across the conditions, nor did the total energy consumed. These data suggest that social influences on food choice are limited in this context but the presence of an 'unhealthy' eating partner may undermine intentions to consume low-energy-dense foods.
Bell, Colin; Pond, Nicole; Davies, Lynda; Francis, Jeryl Lynn; Campbell, Elizabeth; Wiggers, John
Vending machines and shops located within health care facilities are a source of food and drinks for staff, visitors and outpatients and they have the potential to promote healthy food and drink choices. This paper describes perceptions of parents and managers of health-service located food outlets towards the availability and labelling of healthier food options and the food and drinks offered for sale in health care facilities in Australia. It also describes the impact of an intervention to improve availability and labelling of healthier foods and drinks for sale. Parents (n = 168) and food outlet managers (n = 17) were surveyed. Food and drinks for sale in health-service operated food outlets (n = 5) and vending machines (n = 90) in health care facilities in the Hunter New England region of NSW were audited pre (2007) and post (2010/11) the introduction of policy and associated support to increase the availability of healthier choices. A traffic light system was used to classify foods from least (red) to most healthy choices (green). Almost all (95%) parents and most (65%) food outlet managers thought food outlets on health service sites should have signs clearly showing healthy choices. Parents (90%) also thought all food outlets on health service sites should provide mostly healthy items compared to 47% of managers. The proportion of healthier beverage slots in vending machines increased from 29% to 51% at follow-up and the proportion of machines that labelled healthier drinks increased from 0 to 26%. No outlets labelled healthier items at baseline compared to 4 out of 5 after the intervention. No changes were observed in the availability or labelling of healthier food in vending machines or the availability of healthier food or drinks in food outlets. Baseline availability and labelling of healthier food and beverage choices for sale in health care facilities was poor in spite of the support of parents and outlet managers for such initiatives. The intervention
Mikkelsen, Mette Vang; Husby, Sofie; Skov, Laurits Rohden
Background With the worldwide levels of obesity new venues for promotion of healthy eating habits are necessary. Considering children's eating habits are founded during their preschool years early educational establishments are a promising place for making health promoting interventions. Methods...... This systematic review evaluates different types of healthy eating interventions attempting to prevent obesity among 3 to 6 year-olds in preschools, kindergartens and day care facilities. Studies that included single interventions, educational interventions and/or multicomponent interventions were eligible...
McArthur, Laura H; Valentino, Antonette; Holbert, Donald
This cross-sectional survey study compared the on- and off-campus snack choices and related correlates of convenience samples of exercise science (ES) ( n = 165, M = 45%, F = 55%) and non-exercise science (NES) ( n =160, M = 43%, F = 57%) undergraduates. The hypothesis posed was that knowledge of healthy foods will not translate to healthier snack consumption by the ES students, and that the snack choices and related correlates of ES and NES students will be similar. Data were collected using self-administered questionnaires completed in classrooms (ES sample) and at high-traffic locations on-campus (NES sample). Chi-square and t-test analyses compared ES and NES students on snack correlates. Snacks consumed most often by the ES and NES students on-campus were health bars/squares ( n = 56 vs. n = 48) and savory snacks ( n = 55 vs. n = 71), and off-campus were savory snacks ( n = 60 vs. n = 71) and fruits ( n = 41 vs. n = 34). Over half of both samples believed their snack choices were a mix of unhealthy and healthy. Fruits were considered healthier snacks and chips less healthy by both samples, and fruits were the most often recommended snack. About 20% believed these choices would impact their health unfavorably, and about two thirds self-classified in the action stages for healthy snacking. Since knowledge about healthy food choices did not translate to healthy snack selection, these students would benefit from interventions that teach selection and preparation of healthy snacks on a restricted budget.
Achananuparp, Palakorn; Lim, Ee-Peng; Abhishek, Vibhanshu
Past research has shown the benefits of food journaling in promoting mindful eating and healthier food choices. However, the links between journaling and healthy eating have not been thoroughly examined. Beyond caloric restriction, do journalers consistently and sufficiently consume healthful diets? How different are their eating habits compared to those of average consumers who tend to be less conscious about health? In this study, we analyze the healthy eating behaviors of active food journ...
Harding, I H; Andrews, Z B; Mata, F; Orlandea, S; Martínez-Zalacaín, I; Soriano-Mas, C; Stice, E; Verdejo-Garcia, A
Unhealthy dietary choices are a major contributor to harmful weight gain and obesity. This study interrogated the brain substrates of unhealthy versus healthy food choices in vivo, and evaluated the influence of hunger state and body mass index (BMI) on brain activation and connectivity. Thirty adults (BMI: 18-38 kg m -2 ) performed a food-choice task involving preference-based selection between beverage pairs consisting of high-calorie (unhealthy) or low-calorie (healthy) options, concurrent with functional magnetic resonance imaging (fMRI). Selected food stimuli were delivered to participants using an MRI-compatible gustometer. fMRI scans were performed both after 10-h fasting and when sated. Brain activation and hypothalamic functional connectivity were assessed when selecting between unhealthy-healthy beverage pairings, relative to unhealthy-unhealthy and healthy-healthy options. Results were considered significant at cluster-based family-wise error corrected Pfoods elicited significant activation in the hypothalamus, the medial and dorsolateral prefrontal cortices, the anterior insula and the posterior cingulate. Hunger was associated with higher activation within the ventromedial and dorsolateral prefrontal cortices, as well as lower connectivity between the hypothalamus and both the ventromedial prefrontal cortex and dorsal striatum. Critically, people with higher BMI showed lower activation of the hypothalamus-regardless of hunger state-and higher activation of the ventromedial prefrontal cortex when hungry. People who are overweight and obese have weaker activation of brain regions involved in energy regulation and greater activation of reward valuation regions while making choices between unhealthy and healthy foods. These results provide evidence for a shift towards hedonic-based, and away from energy-based, food selection in obesity.
Anzman-Frasca, Stephanie; Braun, Abbey C; Ehrenberg, Sarah; Epstein, Leonard H; Gampp, April; Leone, Lucia A; Singh, Anita; Tauriello, Sara
Children's consumption of restaurant foods is associated with higher energy intake and lower nutritional quality compared to foods prepared at home. The aim of this pilot study was to test whether an in-restaurant intervention promoting healthy children's meals (i.e. two meals that met nutrition recommendations and were thus healthier than typical children's meal offerings across leading restaurants) affected children's meal selection and intake. Families with 4-to-8-year-old children were recruited from one location of Anderson's Frozen Custard, a regional quick-service restaurant chain. Families were randomly assigned to return to the restaurant during an intervention or control period and were blinded to group assignment. All families received free meals. During the intervention period families also received placemats featuring two healthy "Kids' Meals of the Day" upon restaurant entry. After families finished dining, researchers recorded children's orders and collected leftovers for quantifying dietary intake via weighed plate waste. Poisson regression and chi-square tests were used to compare children's orders between study groups, and t-tests were used to test for differences in dietary intake among children ordering a promoted healthy entrée (main dish) versus those who did not. Fifty-eight families participated. Children who were exposed to the study placemats prior to ordering ordered a significantly greater number of healthy food components compared to controls (p = 0.03). Overall, in the intervention group, 21% of children ordered a healthy entrée or side dish, versus 7% of controls. Children who ordered one of the promoted healthy entrées consumed less saturated fat across the total meal compared to those who did not (p = 0.04). Manipulating the prominence of healthy choices in restaurants may shift children's meal selections. Future research should build on these initial promising results, aiming to increase the potency of the intervention
Traill, W. B.; Shankar, B.; Branbila-Macias, J.
Although in several EU Member States many public interventions have been running for the prevention and/or management of obesity and other nutritionrelated health conditions, few have yet been formally evaluated. The multidisciplinary team of the EATWELL project will gather benchmark data...... on healthy eating interventions in EU Member States and review existing information on the effectiveness of interventions using a three-stage procedure (i) Assessment of the intervention's impact on consumer attitudes, consumer behaviour and diets; (ii) The impact of the change in diets on obesity and health...... and (iii) The value attached by society to these changes, measured in life years gained, cost savings and quality-adjusted life years. Where evaluations have been inadequate, EATWELL will gather secondary data and analyse them with a multidisciplinary approach incorporating models from the psychology...
Houlby, Louise; Nørnberg, Trine R.; Skov, Laurits Rohden
through an online quantitative questionnaire, which was developed, validated and distributed to assess factors associated with attitude towards choice architectural nudge interventions. Data analysis included descriptive statistics, factor analysis and structural equation modelling. A total of 408...... towards choice architectural nudge interventions. Also, social norms were positively associated with the outcome. Perceived vegetable intake and buffet habits attaching importance to animal welfare and organic food had a negative association. The descriptive analysis found that the respondents were......Objective: The objective of this study was to investigate the attitudes towards choice architectural nudge interventions aiming to increase vegetable intake among Danish teenagers in a school context, and which factors influence these attitudes. Methodology: Cross-sectional data were collected...
Brambila-Macias, Jose; Shankar, Bhavani; Capacci, Sara; Mazzocchi, Mario; Perez-Cueto, Federico J A; Verbeke, Wim; Traill, W Bruce
Unhealthy diets can lead to various diseases, which in turn can translate into a bigger burden for the state in the form of health services and lost production. Obesity alone has enormous costs and claims thousands of lives every year. Although diet quality in the European Union has improved across countries, it still falls well short of conformity with the World Health Organization dietary guidelines. In this review, we classify types of policy interventions addressing healthy eating and identify through a literature review what specific policy interventions are better suited to improve diets. Policy interventions are classified into two broad categories: information measures and measures targeting the market environment. Using this classification, we summarize a number of previous systematic reviews, academic papers, and institutional reports and draw some conclusions about their effectiveness. Of the information measures, policy interventions aimed at reducing or banning unhealthy food advertisements generally have had a weak positive effect on improving diets, while public information campaigns have been successful in raising awareness of unhealthy eating but have failed to translate the message into action. Nutritional labeling allows for informed choice. However, informed choice is not necessarily healthier; knowing or being able to read and interpret nutritional labeling on food purchased does not necessarily result in consumption of healthier foods. Interventions targeting the market environment, such as fiscal measures and nutrient, food, and diet standards, are rarer and generally more effective, though more intrusive. Overall, we conclude that measures to support informed choice have a mixed and limited record of success. On the other hand, measures to target the market environment are more intrusive but may be more effective.
Nioi, Amanda; Wendelboe-Nelson, Charlotte; Cowan, Sue; Cowie, Hilary; Rashid, Shahzad; Ritchie, Peter; Cherrie, Mark; Lansdown, Terry C; Cherrie, John W
Exposure to sunlight can have both positive and negative health impacts. Excessive exposure to ultra-violet (UV) radiation from the sun can cause skin cancer, however insufficient exposure to sunlight has a detrimental effect on production of Vitamin D. In the construction industry there are onsite proactive behaviours for safety, but sun-safety remains a low priority. There is limited research on understanding the barriers to adopting sun-safe behaviours and the association this may have with Vitamin D production. This paper reports a protocol for an intervention study, using text messaging in combination with a supportive smartphone App. The intervention aims to both reduce UV exposure during months with higher UV levels and promote appropriate dietary changes to boost Vitamin D levels during months with low UV levels. Approximately 60 construction workers will be recruited across the United Kingdom. A randomised control crossover trial (RCCT) will be used to test the intervention, with randomisation at site level - i.e. participants will receive both the control (no text messages or supportive App support) and intervention (daily text messages and supportive App). Using the Theory of Planned Behaviour (TPB) the intervention focuses on supporting sun-safety and healthy dietary decisions in relation to Vitamin D intake. The intervention emphasises cultivating the perception of normative support in the workplace, increasing awareness of control and self-efficacy in taking sun-protective behaviours, making healthier eating choices to boost Vitamin D, and tackling stigmas attached to image and group norms. Each study epoch will last 21 days with intervention text messages delivered on workdays only. The supportive App will provide supplementary information about sun protective behaviours and healthy dietary choices. The primary outcome measure is 25-hydroxy-Vitamin D [25(OH)D] level (obtained using blood spot sampling), which will be taken pre and post control and
Koivisto, Petri; Vinokur, Amiram D.; Vuori, Jukka
This randomized experimental study (N = 1,034) examines both the direct and the indirect effects of the Towards Working Life intervention on 2 components of adolescents' career preparation: preparedness for career choice and attitude toward career planning. The intervention comprised a 1-week workshop program, the proximal goals of which were to…
DeBar, LL; Schneider, M; Ford, EG; Hernandez, AE; Showell, B; Drews, KL; Moe, EL; Gillis, B; Jessup, AN; Stadler, DD; White, M
The HEALTHY study was a randomized, controlled, multicenter, middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Participants were a racially, ethnically and geographically diverse cohort from across the United States. Here, we describe the conceptual underpinnings and design of the social marketing-based communications component of the HEALTHY study intervention that combined changes in the school nutrition and physical education (PE) environment with behavior change initiatives. The communications intervention component coordinated multiple elements to deliver campaigns that served to integrate and support all aspects of the HEALTHY intervention. The campaigns unfolded across five semesters of middle school, each targeting a specific theme related to the HEALTHY objectives. Communications campaigns comprised (1) core elements such as branding, posters, banners and visual and verbal messaging, (2) student events supporting the nutrition, PE and behavior intervention components through the application of social marketing and communications strategies, including the incorporation of student-generated media and (3) distribution of premiums and theme enhancers to extend the visibility of the study beyond the intervention environment. Formative research conducted with students, parents and school administrators was used to refine the communications strategy. Student peer communicators selected from the student body were involved to influence the normative student environment. Marketing and creative design experts developed a brand, logo, activities and materials. In the latter half of the study, student-generated messages and media were used to reflect local interests and culture and enhance peer influence. The HEALTHY intervention delivery and impact were strengthened by the
DeBar, L L; Schneider, M; Ford, E G; Hernandez, A E; Showell, B; Drews, K L; Moe, E L; Gillis, B; Jessup, A N; Stadler, D D; White, M
The HEALTHY study was a randomized, controlled, multicenter, middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Participants were a racially, ethnically and geographically diverse cohort from across the United States. Here, we describe the conceptual underpinnings and design of the social marketing-based communications component of the HEALTHY study intervention that combined changes in the school nutrition and physical education (PE) environment with behavior change initiatives. The communications intervention component coordinated multiple elements to deliver campaigns that served to integrate and support all aspects of the HEALTHY intervention. The campaigns unfolded across five semesters of middle school, each targeting a specific theme related to the HEALTHY objectives. Communications campaigns comprised (1) core elements such as branding, posters, banners and visual and verbal messaging, (2) student events supporting the nutrition, PE and behavior intervention components through the application of social marketing and communications strategies, including the incorporation of student-generated media and (3) distribution of premiums and theme enhancers to extend the visibility of the study beyond the intervention environment. Formative research conducted with students, parents and school administrators was used to refine the communications strategy. Student peer communicators selected from the student body were involved to influence the normative student environment. Marketing and creative design experts developed a brand, logo, activities and materials. In the latter half of the study, student-generated messages and media were used to reflect local interests and culture and enhance peer influence. The HEALTHY intervention delivery and impact were strengthened by the
Wald, Ellen R; Ewing, Linda J; Moyer, Stacey C L; Eickhoff, Jens C
This prospective, randomized, controlled trial for parents of overweight and obese 3- to 7-year-olds was performed to assess the feasibility of a program promoting healthy eating and lifestyle by targeting parents as agents of change. The intervention was composed of 6-in-person group sessions and a customized website over 12 months. The control group received customary care. The primary outcome was feasibility of the intervention to promote healthy behavior change measured by attendance. The secondary outcome was effectiveness assessed by attaining reduced body mass index (BMI) z scores, healthy behavior changes and increased parent self-efficacy. Seventy-three child-parent dyads were enrolled; 14 parents never attended any sessions. Participation in follow-up assessments did not meet the hypothesized level. Ultimate BMI z scores did not differ between control and intervention groups. Parenting skills did not improve in the intervention group. This intervention to achieve healthy lifestyle changes in children via their parents as "change agents" was unsuccessful.
Finderup, Jeanette; Jensen, Jens K D; Lomborg, Kirsten
Evidence is inconclusive on how best to guide the patient in decision-making around haemodialysis and peritoneal dialysis choice. International guidelines recommend involvement of the patient in the decision to choose the dialysis modality most suitable for the individual patient. Nevertheless, studies have shown lack of involvement of the patient in decision-making. To develop and pilot test an intervention for shared decision-making targeting the choice of dialysis modality. This study reflects the first two phases of a complex intervention design: phase 1, the development process and phase 2, feasibility and piloting. Because decision aids were a part of the intervention, the International Patient Decision Aid Standards were considered. The pilot test included both the intervention and the feasibility of the validated shared decision-making questionnaire (SDM Q9) and the Decision Quality Measure (DQM) applied to evaluate the intervention. A total of 137 patients tested the intervention. After the intervention, 80% of the patients chose dialysis at home reflecting an increase of 23% in starting dialysis at home prior to the study. The SDM Q9 showed the majority of the patients experienced this intervention as shared decision-making. An intervention based on shared decision-making supported by decision aids seemed to increase the number of patients choosing home dialysis. The SDM Q9 and DQM were feasible evaluation tools. Further research is needed to gain insight into the patients' experiences of involvement and the implications for their choice of dialysis modality. © 2018 European Dialysis and Transplant Nurses Association/European Renal Care Association.
Merkx, Astrid; Ausems, Marlein; de Vries, Raymond; Nieuwenhuijze, Marianne J
Gaining too much or too little weight in pregnancy (according to Institute of Medicine (IOM) guidelines) negatively affects both mother and child, but many women find it difficult to manage their gestational weight gain (GWG). Here we describe the use of the intervention mapping protocol to design 'Come On!', an intervention to promote adequate GWG among healthy pregnant women. We used the six steps of intervention mapping: (i) needs assessment; (ii) formulation of change objectives; (iii) selection of theory-based methods and practical strategies; (iv) development of the intervention programme; (v) development of an adoption and implementation plan; and (vi) development of an evaluation plan. A consortium of users and related professionals guided the process of development. As a result of the needs assessment, two goals for the intervention were formulated: (i) helping healthy pregnant women to stay within the IOM guidelines for GWG; and (ii) getting midwives to adequately support the efforts of healthy pregnant women to gain weight within the IOM guidelines. To reach these goals, change objectives and determinants influencing the change objectives were formulated. Theories used were the Transtheoretical Model, Social Cognitive Theory and the Elaboration Likelihood Model. Practical strategies to use the theories were the foundation for the development of 'Come On!', a comprehensive programme that included a tailored Internet programme for pregnant women, training for midwives, an information card for midwives, and a scheduled discussion between the midwife and the pregnant woman during pregnancy. The programme was pre-tested and evaluated in an effect study.
Mazza, Mary Carol; Dynan, Linda; Siegel, Robert M; Tucker, Anita L
More than two thirds of adults and one third of children are overweight or obese in the United States. These trends have led to initiatives to provide information that supports informed choices. Traffic light labeling has been shown to increase consumer awareness and encourage healthy selections. This article contributes to the literature on healthy choices by comparing the additional contribution of a number of interventions used in combination with traffic light labeling. We conducted a 21-month field study in a workplace cafeteria. We analyzed cash register receipts, focusing on sales of beverages and chips. We found that the traffic light system was effective. The addition of caloric information to traffic light labeling had a positive effect on the purchase of healthy chips. However, other interventions appeared to produce more harm than good, essentially wiping out the benefits from traffic light labeling. These findings suggest that although it is possible to improve on traffic light labeling with selective interventions, caution is in order as some interventions may trigger compensatory behavior that results in the purchase of unhealthy items.
Mah, Catherine L; Minaker, Leia M; Jameson, Kristie; Rappaport, Lissie; Taylor, Krystal; Graham, Marketa; Moody, Natalie; Cook, Brian
The majority of Canadians' food acquisition occurs in retail stores. Retail science has become increasingly sophisticated in demonstrating how consumer environments influence population-level diet quality and health status. The retail food environment literature is new but growing rapidly in Canada, and there is a relative paucity of evidence from intervention research implemented in Canada. The healthy corner store model is a comprehensive complex population health intervention in small retail stores, intended to transform an existing business model to a health-promoting one through intersectoral collaboration. Healthy corner store interventions typically involve conversions of existing stores with the participation of health, community, and business sector partners, addressing business fundamentals, merchandising, and consumer demand. This article introduces pioneering experiences with the healthy corner store intervention in Canada. First, we offer a brief overview of the state of evidence within and outside Canada. Second, we discuss three urban and one rural healthy corner store initiatives, led through partnerships among community food security organizations, public health units, academics, and business partners, in Manitoba, Ontario, and Newfoundland and Labrador. Third, we synthesize the promising practices from these local examples, including aspects of both intervention science (e.g., refinements in measuring the food environment) and community-based practice (e.g., dealing with unhealthy food items and economic impact for the retailer). This article will synthesize practical experiences with healthy corner stores in Canada. It offers a baseline assessment of promising aspects of this intervention for health and health equity, and identifies opportunities to strengthen both science and practice in this area of retail food environment work.
Houlby, Louise; Nørnberg, Trine R.; Skov, Laurits Rohden; Perez-Cueto, Armando
Objective: The objective of this study was to investigate the attitudes towards choice architectural nudge interventions aiming to increase vegetable intake among Danish teenagers in a school context, and which factors influence these attitudes.Methodology: Cross-sectional data were collected through an online quantitative questionnaire, which was developed, validated and distributed to assess factors associated with attitude towards choice architectural nudge interventions. Data analysis inc...
Grogan Sarah C
Full Text Available Abstract Background There is growing recognition that a sedentary lifestyle is being driven, at least in part, by environmental factors that affect individuals' physical activity choices and health behaviours. In other words, the environments in which we live, and with which we interact, have become ones that encourage lifestyle choices that decrease physical activity and encourage over-consumption of foods. However, evidence from community-led interventions to change local neighbourhood environments to support physical activity and healthy eating is lacking. This article summarises the research protocol developed to evaluate a community-led intervention "My Health Matters" aimed at reducing health inequalities relating to increasing physical activity and healthy eating as defined by community members themselves. Methods/Design This study includes three of the most deprived electoral wards in Stoke-on-Trent. In each of these areas, environmental factors including proximity of physical activity spaces, greenspace and leisure facilities, neighbourhood connectivity and walkability, land-use-mix and population density, traffic, safety and crime, and food outlets will be mapped using Geographical Information Systems (GIS. A community postal survey of randomly selected addresses assessing environmental characteristics relating to physical activity, perceived health status, social capital, fruit and vegetable consumption and levels of physical activity will be undertaken (baseline and at 2 year follow-up. Based on baseline findings an intervention will be designed and implemented over a 2 year period that includes the following; use of community participatory research to build effective community partnerships; use of partnership consensus to identify, prioritise and design intervention(s related to specific health disparities; recruitment of local residents to help with the delivery and sustainability of target intervention(s; and the development of
Davey, Rachel C; Hurst, Gemma L; Smith, Graham R; Grogan, Sarah C; Kurth, Judy
There is growing recognition that a sedentary lifestyle is being driven, at least in part, by environmental factors that affect individuals' physical activity choices and health behaviours. In other words, the environments in which we live, and with which we interact, have become ones that encourage lifestyle choices that decrease physical activity and encourage over-consumption of foods. However, evidence from community-led interventions to change local neighbourhood environments to support physical activity and healthy eating is lacking. This article summarises the research protocol developed to evaluate a community-led intervention "My Health Matters" aimed at reducing health inequalities relating to increasing physical activity and healthy eating as defined by community members themselves. This study includes three of the most deprived electoral wards in Stoke-on-Trent. In each of these areas, environmental factors including proximity of physical activity spaces, greenspace and leisure facilities, neighbourhood connectivity and walkability, land-use-mix and population density, traffic, safety and crime, and food outlets will be mapped using Geographical Information Systems (GIS). A community postal survey of randomly selected addresses assessing environmental characteristics relating to physical activity, perceived health status, social capital, fruit and vegetable consumption and levels of physical activity will be undertaken (baseline and at 2 year follow-up). Based on baseline findings an intervention will be designed and implemented over a 2 year period that includes the following; use of community participatory research to build effective community partnerships; use of partnership consensus to identify, prioritise and design intervention(s) related to specific health disparities; recruitment of local residents to help with the delivery and sustainability of target intervention(s); and the development of local systems for ongoing monitoring and evaluation
Winkler, Lise L; Christensen, Ulla; Glümer, Charlotte
BACKGROUND: The widespread use of in-store marketing strategies to induce unhealthy impulsive purchases has implications for shopping experience, food choice and possibly adverse health outcomes. The aim of this study was to examine consumer attitudes and evaluate sales effects of a healthy...... short in-store interviews, 11 semi-structured interviews and three focus group interviews). Findings were presented to food retailers and informed the decision to test a healthy checkout intervention. Sugar confectionery at one checkout counter was substituted with fruit and healthy snacking items...... intervention awareness was modest. Most participants believed that the intervention could help other consumers make healthier choices, while fewer expected to be influenced by the intervention themselves. Statistical analyses suggested an intervention effect on sales of carrot snack packs when compared...
Shimazaki, Takashi; Bao, Hugejiletu; Deli, Geer; Uechi, Hiroaki; Lee, Ying-Hua; Miura, Kayo; Takenaka, Koji
Unhealthy eating behavior is a serious health concern among secondary school students in Inner Mongolia. To predict their healthy food choices and devise methods of correcting unhealthy choices, we sought to confirm the cross-cultural validity of the theory of planned behavior among Inner Mongolian students. A cross-sectional study, conducted between November and December 2014. Overall, 3047 students were enrolled. We devised a questionnaire based on the theory of planned behavior to measure its components (intentions, attitudes, subjective norms, and perceived behavioral control) in relation to healthy food choices; we also assessed their current engagement in healthy food choices. A principal component analysis revealed high contribution rates for the components (69.32%-88.77%). A confirmatory factor analysis indicated that the components of the questionnaire had adequate model fit (goodness of fit index=0.997, adjusted goodness of fit index=0.984, comparative fit index=0.998, and root mean square error of approximation=0.049). Notably, data from participants within the suburbs did not support the theory of planned behavior construction. Several paths did not predict the hypothesis variables. However, attitudes toward healthy food choices strongly predicted behavioral intention (path coefficients 0.49-0.77, ptheory of planned behavior can apply to secondary school students in urban areas. Furthermore, attitudes towards healthy food choices were the best predictor of behavioral intentions to engage in such choices in Inner Mongolian students. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Pedersen, Susanne; Grønhøj, Alice; Bech-Larsen, Tino
Purpose - Healthy-eating socialization is often described as a bi-directional process, but there are only few studies on children and parent’s roles in the process. This paper investigates children and parents’ accounts of awareness and involvement in healthy eating and how they relate it to thei......Purpose - Healthy-eating socialization is often described as a bi-directional process, but there are only few studies on children and parent’s roles in the process. This paper investigates children and parents’ accounts of awareness and involvement in healthy eating and how they relate...... it to their roles in healthy-eating socialization. Design/methodology/approach - Semi-structured interviews were conducted with 38 families three months after a healthy-eating intervention involving dietary advice and SMS feedback. The interviews were analysed by means of qualitative content analysis. Findings...... or a cooperative strategy helping the parents. Parents initiated dialogues with family members about healthy eating and felt responsible as role models often honouring the children’s demands and help. Research limitations/implications - Findings provide a concrete empirical account of the socialization process...
Gillis, B; Mobley, C; Stadler, D D; Hartstein, J; Virus, A; Volpe, S L; El ghormli, L; Staten, M A; Bridgman, J; McCormick, S
The HEALTHY study was a randomized, controlled, multicenter and middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Here we describe the design of the HEALTHY nutrition intervention component that was developed to modify the total school food environment, defined to include the following: federal breakfast, lunch, after school snack and supper programs; a la carte venues, including snack bars and school stores; vending machines; fundraisers; and classroom parties and celebrations. Study staff implemented the intervention using core and toolbox strategies to achieve and maintain the following five intervention goals: (1) lower the average fat content of foods, (2) increase the availability and variety of fruits and vegetables, (3) limit the portion sizes and energy content of dessert and snack foods, (4) eliminate whole and 2% milk and all added sugar beverages, with the exception of low fat or nonfat flavored milk, and limit 100% fruit juice to breakfast in small portions and (5) increase the availability of higher fiber grain-based foods and legumes. Other nutrition intervention component elements were taste tests, cafeteria enhancements, cafeteria line messages and other messages about healthy eating, cafeteria learning laboratory (CLL) activities, twice-yearly training of food service staff, weekly meetings with food service managers, incentives for food service departments, and twice yearly local meetings and three national summits with district food service directors. Strengths of the intervention design were the integration of nutrition with the other HEALTHY intervention components (physical education, behavior change and communications), and the collaboration and rapport between the nutrition intervention study staff members and food service personnel at both school
Choi, Hojoon; Reid, Leonard N
Fast food restaurants have increasingly turned to healthier choices to counter criticisms of nutritionally poor menu offerings and to differentiate themselves from the competition. However, research has yet to specifically investigate how consumers respond to advertisements for these healthier foods. To address this knowledge gap, two experiments were conducted to examine how perceived brand healthiness, brand commitment, and health consciousness influence responses to nutrient-content claimed print advertisements for healthy foods. Findings indicate that consumer responsiveness varies across the three factors but is more positive for advertisements placed by perceivably healthy restaurant brands, and that brand commitment and health consciousness play significant roles in affecting how consumer respond to such advertising. Several theoretical and managerial implications of the findings are discussed.
Droog, S.M. de
Worldwide the number of overweight children rises dramatically. One way to prevent overweight is by creating healthy eating habits from a very young age. This dissertation explores whether and how 4- to 6-year-olds’ fruit and vegetable choices can be stimulated by using an immensely popular
van Kleef, Ellen; Otten, Kai; van Trijp, Hans C M
The essence of nudging is to adapt the environment in which consumers make decisions to help them make better choices, without forcing certain outcomes upon them. To determine how consumers can effectively be guided to select healthier snacks, we examine the effect of manipulating the assortment structure and shelf layout of an impulse display including both healthy and unhealthy snacks near the checkout counter of a canteen. Both a lab and field study applied a two-factor experimental design manipulating snack offerings both in an on-screen choice environment and a natural environment (hospital staff restaurant). Shelf arrangement (i.e. accessibility) was altered by putting healthy snacks at higher shelves versus lower shelves. Assortment structure (i.e. availability) was altered by offering an assortment that either included 25% or 75% healthy snacks. Participants in the lab study (n = 158) made a choice from a shelf display. A brief survey following snack selection asked participants to evaluate the assortment and their choice. The field experiment took place in a hospital canteen. Daily sales data were collected for a period of four weeks. On completion of the field study, employees (n = 92) filled out a questionnaire about all four displays and rated their attractiveness, healthiness and perceived freedom of choice. The lab study showed a higher probability of healthy snack choice when 75% of the assortment consisted of healthy snacks compared to conditions with 25% healthy snack assortments, even though choices were not rated less satisfying or more restrictive. Regarding shelf display location of healthy snacks, no significant differences were observed. There was also no significant shelf arrangement by assortment structure interactive effect. The field study replicated these findings, in that this assortment structure led to higher sales of healthy snacks. Sales of unhealthy and total snacks were not impacted by manipulations (no main or interaction effects
van Kleef Ellen
Full Text Available Abstract Background The essence of nudging is to adapt the environment in which consumers make decisions to help them make better choices, without forcing certain outcomes upon them. To determine how consumers can effectively be guided to select healthier snacks, we examine the effect of manipulating the assortment structure and shelf layout of an impulse display including both healthy and unhealthy snacks near the checkout counter of a canteen. Methods Both a lab and field study applied a two-factor experimental design manipulating snack offerings both in an on-screen choice environment and a natural environment (hospital staff restaurant. Shelf arrangement (i.e. accessibility was altered by putting healthy snacks at higher shelves versus lower shelves. Assortment structure (i.e. availability was altered by offering an assortment that either included 25% or 75% healthy snacks. Participants in the lab study (n = 158 made a choice from a shelf display. A brief survey following snack selection asked participants to evaluate the assortment and their choice. The field experiment took place in a hospital canteen. Daily sales data were collected for a period of four weeks. On completion of the field study, employees (n = 92 filled out a questionnaire about all four displays and rated their attractiveness, healthiness and perceived freedom of choice. Results The lab study showed a higher probability of healthy snack choice when 75% of the assortment consisted of healthy snacks compared to conditions with 25% healthy snack assortments, even though choices were not rated less satisfying or more restrictive. Regarding shelf display location of healthy snacks, no significant differences were observed. There was also no significant shelf arrangement by assortment structure interactive effect. The field study replicated these findings, in that this assortment structure led to higher sales of healthy snacks. Sales of unhealthy and total snacks were
Background The essence of nudging is to adapt the environment in which consumers make decisions to help them make better choices, without forcing certain outcomes upon them. To determine how consumers can effectively be guided to select healthier snacks, we examine the effect of manipulating the assortment structure and shelf layout of an impulse display including both healthy and unhealthy snacks near the checkout counter of a canteen. Methods Both a lab and field study applied a two-factor experimental design manipulating snack offerings both in an on-screen choice environment and a natural environment (hospital staff restaurant). Shelf arrangement (i.e. accessibility) was altered by putting healthy snacks at higher shelves versus lower shelves. Assortment structure (i.e. availability) was altered by offering an assortment that either included 25% or 75% healthy snacks. Participants in the lab study (n = 158) made a choice from a shelf display. A brief survey following snack selection asked participants to evaluate the assortment and their choice. The field experiment took place in a hospital canteen. Daily sales data were collected for a period of four weeks. On completion of the field study, employees (n = 92) filled out a questionnaire about all four displays and rated their attractiveness, healthiness and perceived freedom of choice. Results The lab study showed a higher probability of healthy snack choice when 75% of the assortment consisted of healthy snacks compared to conditions with 25% healthy snack assortments, even though choices were not rated less satisfying or more restrictive. Regarding shelf display location of healthy snacks, no significant differences were observed. There was also no significant shelf arrangement by assortment structure interactive effect. The field study replicated these findings, in that this assortment structure led to higher sales of healthy snacks. Sales of unhealthy and total snacks were not impacted by
Donaldson-Feilder, Emma; Lewis, Rachel; Pavey, Louisa; Jones, Bethan; Green, Melanie; Webster, Angela
Objective: The objective of this study was to examine employees' perceived barriers and facilitators of physical activity and healthy dietary choices, and managers' perceptions of how best to facilitate physical activity and healthy dietary choices among their team members. Design: Single time-point survey with categorical and open-ended…
Nicholson, Jody S; Barton, Jennifer M; Simons, Ali L
To investigate whether preschoolers are able to identify and categorize foods, and whether their ability to classify food as healthy predicts their hypothetical food choice. Structured interviews and body measurements with preschoolers, and teacher reports of classroom performance. Six Head Start centers in a large southeastern region. A total of 235 preschoolers (mean age [SD], 4.73 [0.63] years; 45.4% girls). Teachers implemented a nutrition education intervention across the 2014-2015 school year in which children were taught to identify and categorize food as sometimes (ie, unhealthy) and anytime (ie, healthy). Preschooler responses to a hypothetical snack naming, classifying, and selection scenario. Hierarchical regression analyses to examine predictors of child hypothetical food selection. While controlling for child characteristics and cognitive functioning, preschoolers who were better at categorizing food as healthy or unhealthy were more likely to say they would choose the healthy food. Low-contrast food pairs in which food had to be classified based on multiple dimensions were outside the cognitive abilities of the preschoolers. Nutrition interventions may be more effective in helping children make healthy food choices if developmental limitations in preschoolers' abilities to categorize food is addressed in their curriculum. Classification of food into evaluative categories is challenging for this age group. Categorizing on multiple dimensions is difficult, and dichotomous labeling of food as good or bad is not always accurate in directing children toward making food choices. Future research could evaluate further preschoolers' developmental potential for food categorization and nutrition decision making and consider factors that influence healthy food choices at both snack and mealtime. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Privitera, Gregory J; Phillips, Taylor E; Zuraikat, Faris M; Paque, Robert
Health literacy, the ability to acquire health-related knowledge and make appropriate health-related decisions, is regarded as a key barrier to meaningfully convey health information to children and can impact food choice. Emolabeling is an image-based labeling strategy aimed at addressing this problem by conveying health information using emotional correlates of health using emoticons (happy = healthy; sad = not healthy). To test the utility of such a method to promote healthy food choices among children, 64 children (59% girls, foods in each of 2 aisles structured to mimic a grocery aisle - there were 12 identical foods placed in the same location in each aisle with half being low calorie and half high calorie snacks. Foods were emolabeled in one aisle; no emolabels were used in the other aisle; the order that children were brought in each aisle was counterbalanced. Results showed that adding emolabels increased the number (M ± SD) of healthy foods chosen (3.6 ± 0.7 with vs. 2.3 ± 1.1 without emolabels present [95% CI 1.0, 1.5], R(2) = .67) and reduced the total calories (M ± SD) of foods chosen (193.5 ± 88.5 Cal with vs. 374.3 ± 152.6 Cal without emolabels present [95% CI -212.6, -149.0], R(2) = .70). Hence, adding emolabels was associated with healthier food choices among children, thereby demonstrating one possible strategy to effectively overcome health literacy barriers at these ages. Copyright © 2015 Elsevier Ltd. All rights reserved.
Waterlander, Wilma E; Steenhuis, Ingrid H M; de Boer, Michiel R; Schuit, Albertine J; Seidell, Jacob C
Two strategies commonly recommended to improve population diets include food labels and food taxes/subsidies. The aim of this study was to examine the effects of both strategies separately and in combination. An experiment with a 3x3 factorial design was conducted, including: three levels of price reduction (10%; 25%; and 50%) x three labels ('special offer', 'healthy choice' and 'special offer & healthy choice') on healthy foods defined following the Choices front-of-pack nutrition label. N=109 participants completed the experiment by conducting a typical weekly shop for their household at a three-dimensional web-based supermarket. Data were analysed using analysis of covariance. Participants receiving a 50% price discount purchased significantly more healthy foods for their household in a typical weekly shop than the 10% discount (+8.7 items; 95%CI=3.8-13.6) and the 25% discount group (+7.7 items; 95%CI=2.74 - 12.6). However, the proportion of healthy foods was not significantly higher and the discounts lead to an increased amount of energy purchased. No significant effects of the labels were found. This study brings some relevant insights into the effects of price discounts on healthier foods coupled with different labels and shows that price effects over shadowed food labels. However, price discounts seem to have ambiguous effects; they do encourage the purchase of healthy products, but also lead to increased energy purchases. More research is needed to examine how pricing strategies can work in directing consumers towards interchanging unhealthier options for healthier alternatives.
Escaron, Anne L; Martinez-Donate, Ana P; Riggall, Ann Josie; Meinen, Amy; Hall, Beverly; Nieto, F Javier; Nitzke, Susan
Restaurants and food stores are suitable settings for healthy eating interventions. A community-academic partnership developed and implemented "Waupaca Eating Smart" (WES), a healthy eating program in restaurants and supermarkets of a rural, Midwest community. Previous interventions targeted either restaurants or small food stores nearly all in urban areas. Intervention design and implementation is rarely documented, making replication difficult for interested researchers and communities. In this article, we report the activities we undertook to develop and implement WES. Working with a local nutrition and activity coalition, we used evidence-based strategies guided by the social ecological model and social marketing principles to inform the content of WES. Formative assessment included a review of the literature, statewide key informant interviews and focus groups with restaurant and food store operators and patrons, a local community survey, and interviews with prospective WES businesses. WES was implemented in seven restaurants and two supermarkets and evaluated for feasibility and acceptance using surveys and direct observation of WES implementation. Prior to this intervention, only one of seven restaurants had three or more meals that met WES nutrition criteria. By the end of the program, 38 meals were labeled and promoted to restaurant customers, and the team had staffed four side salad taste tests for supermarket customers. Four and 10 months after intervention launch, the majority of the program's strategies were observed in participating outlets, suggesting that these program's strategies are feasible and can be sustained. Operators reported strong satisfaction overall. A combined restaurant- and supermarket-based healthy eating intervention is feasible and positively valued in rural communities. Further research is needed to better understand how to foster sustainability of these interventions and their impact on customer food choices. © 2015 Society for
Background The idea that behaviour can be influenced at population level by altering the environments within which people make choices (choice architecture) has gained traction in policy circles. However, empirical evidence to support this idea is limited, especially its application to changing health behaviour. We propose an evidence-based definition and typology of choice architecture interventions that have been implemented within small-scale micro-environments and evaluated for their effects on four key sets of health behaviours: diet, physical activity, alcohol and tobacco use. Discussion We argue that the limitations of the evidence base are due not simply to an absence of evidence, but also to a prior lack of definitional and conceptual clarity concerning applications of choice architecture to public health intervention. This has hampered the potential for systematic assessment of existing evidence. By seeking to address this issue, we demonstrate how our definition and typology have enabled systematic identification and preliminary mapping of a large body of available evidence for the effects of choice architecture interventions. We discuss key implications for further primary research, evidence synthesis and conceptual development to support the design and evaluation of such interventions. Summary This conceptual groundwork provides a foundation for future research to investigate the effectiveness of choice architecture interventions within micro-environments for changing health behaviour. The approach we used may also serve as a template for mapping other under-explored fields of enquiry. PMID:24359583
Nørnberg, Trine Riebeling; Houlby, Louise; Skov, Laurits Rohden; Peréz-Cueto, Federico Jose Armando
The primary objective of this review is to assess the prevalence and quality of published studies on the effect of choice architectural nudge interventions promoting vegetable consumption among adolescents. Additionally, this review aims to identify studies estimating adolescents' attitude towards choice architectural nudge interventions. Web of Science, Scopus and PubMed were searched systematically for experimental studies with a predefined search strategy in the period November-December 2013. Publications were included following predetermined inclusion criteria. Studies were evaluated as of high, moderate or weak quality. Finally, studies were grouped by the type of intervention and underwent a narrative synthesis. The search showed that only very few studies investigated the effects of choice architectural nudging interventions on vegetable consumption, and none of them had attitude towards behavioural interventions as an outcome measure. Twelve studies met the inclusion criteria. The results of the 12 studies were inconclusive, and the majority of studies were of weak or moderate quality. This review uncovers a gap in knowledge on the effect of choice architectural nudge interventions aiming to promote the intake of vegetables among adolescents in a school context. It also highlights that no previous studies have considered the attitudes towards choice architectural nudge interventions as a potential factor for their success - or lack thereof - in achieving the desired goal of increased vegetable consumption. © Royal Society for Public Health 2015.
Adams, Alexandra K.; LaRowe, Tara L.; Cronin, Kate A.; Prince, Ronald J.; Wubben, Deborah P.; Parker, Tassy; Jobe, Jared B.
Healthy Children, Strong Families (HCSF) is a 2-year, community-driven, family-based randomized controlled trial of a healthy lifestyles intervention conducted in partnership with four Wisconsin American Indian tribes. HCSF is composed of 1 year of targeted home visits to deliver nutritional and physical activity curricula. During Year 1, trained…
Johansen, Susanne Bølling; Næs, Tormod; Hersleth, Margrethe
Understanding consumers' motives for selecting calorie-reduced dairy products are important to provide targeted communication to different consumer segments. The aim of this study was to identify motives for consumption of calorie-reduced dairy products among young consumers, and to identify how these consumers perceive the healthiness of such products compared to other food products. Consumers, aged 18-30 years, from Norway (n=118), Denmark (n=125), and California (n=127) participated in this cross-cultural study. The respondents sorted 24 statements referring to motives for choosing calorie-reduced yoghurt and cheese. The study also assessed the aspect of perceived healthiness of these products in comparison with a selection of other food products using a two-step ranking procedure. The data were analysed using chi-square analysis, Friedman's test and Principal Component Analysis (PCA). The results show that fat content, healthiness and taste were the most important motivators for choice of the calorie-reduced dairy products. In all three countries salmon was perceived as the healthiest among the products presented. The calorie-reduced dairy products were ranked as relatively healthy, with yoghurt ranked as healthier than cheese. Although cross-cultural differences existed in motives for choice and perceived healthiness of the products, the similarities between the countries were evident in this study. Copyright © 2010 Elsevier Ltd. All rights reserved.
Poor lifestyle choices including physical inactivity, adverse nutrition and tobacco use are strongly associated with heart disease, diabetes, respiratory disease and cancer. These four diseases are responsible for over 50% of mortality worldwide. Yet lifestyle intervention is underemphasised in the undergraduate training of ...
Verheijden, M.W.; Kok, F.J.
Community-based interventions have increasingly received attention since researchers and public health professionals have come to acknowledge the importance of an environment that makes the healthy choice the easy choice. All stakeholders including the target community are involved to achieve
Oropeza, Sarah; Sadile, Mary Grace; Phung, Chantine Nguyen; Cabiles, Moana; Spackman, Sandy; Abuan, Myleen; Seligman, Fe; Araneta, Maria Rosario
Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations have elevated prevalence of dietary-related chronic conditions; however, culturally relevant dietary interventions are lacking. This article describes the methodology for a community-based participatory intervention. Strategies to Reach and Implement the Vision of Health Equity, San Diego! aims to increase access to healthy food in AANHPI restaurants, grocery stores, and farmers' markets. Time series quasi-experimental study design. Dietitians, health promotion specialists, and community partners collaborated with restaurant owners and chefs to develop culturally tailored approaches without compromising traditional flavors. AANHPI restaurants in San Diego County, CA. Twenty restaurants and 600 diners are anticipated and will be sampled at 3 intervals for a total of 1,800 diners. We describe the community-based interventions within restaurants, including (1) analyzing and modifying selected recipes to create and promote healthier dishes; (2) providing nutrition labels on selected food items; (3) marketing healthy menu items through food tastings, signage, and social media promotion; and (4) offering low-sodium soy sauce and other condiments. Temporal changes in availability of healthful options, and the frequency of healthy dining choices. Program evaluation consists of assessment of the nutritional environment in 20 participating restaurants and surveys of customers' opinions and behaviors at baseline and at 3 and 12 months postintervention. Fifteen restaurants have been recruited to date. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Gaudreault, Karen Lux; Shiver, Victoria; Kinder, Christopher; Guseman, Emily
Childhood obesity and related health consequences are currently considered some of the most important health challenges in our nation today. Early intervention programs designed to teach healthy lifestyle choices and behaviors are imperative to addressing this issue. Evidence suggests that intervention programs offered at an earlier age may reduce…
Guadalupe X. Ayala
Full Text Available Evidence indicates that restaurant-based interventions have the potential to promote healthier purchasing and improve the nutrients consumed. This study adds to this body of research by reporting the results of a trial focused on promoting the sale of healthy child menu items in independently owned restaurants. Eight pair-matched restaurants that met the eligibility criteria were randomized to a menu-only versus a menu-plus intervention condition. Both of the conditions implemented new healthy child menu items and received support for implementation for eight weeks. The menu-plus condition also conducted a marketing campaign involving employee trainings and promotional materials. Process evaluation data captured intervention implementation. Sales of new and existing child menu items were tracked for 16 weeks. Results indicated that the interventions were implemented with moderate to high fidelity depending on the component. Sales of new healthy child menu items occurred immediately, but decreased during the post-intervention period in both conditions. Sales of existing child menu items demonstrated a time by condition effect with restaurants in the menu-plus condition observing significant decreases and menu-only restaurants observing significant increases in sales of existing child menu items. Additional efforts are needed to inform sustainable methods for improving access to healthy foods and beverages in restaurants.
Ayala, Guadalupe X; Castro, Iana A; Pickrel, Julie L; Lin, Shih-Fan; Williams, Christine B; Madanat, Hala; Jun, Hee-Jin; Zive, Michelle
Evidence indicates that restaurant-based interventions have the potential to promote healthier purchasing and improve the nutrients consumed. This study adds to this body of research by reporting the results of a trial focused on promoting the sale of healthy child menu items in independently owned restaurants. Eight pair-matched restaurants that met the eligibility criteria were randomized to a menu-only versus a menu-plus intervention condition. Both of the conditions implemented new healthy child menu items and received support for implementation for eight weeks. The menu-plus condition also conducted a marketing campaign involving employee trainings and promotional materials. Process evaluation data captured intervention implementation. Sales of new and existing child menu items were tracked for 16 weeks. Results indicated that the interventions were implemented with moderate to high fidelity depending on the component. Sales of new healthy child menu items occurred immediately, but decreased during the post-intervention period in both conditions. Sales of existing child menu items demonstrated a time by condition effect with restaurants in the menu-plus condition observing significant decreases and menu-only restaurants observing significant increases in sales of existing child menu items. Additional efforts are needed to inform sustainable methods for improving access to healthy foods and beverages in restaurants.
Ayala, Guadalupe X.; Castro, Iana A.; Pickrel, Julie L.; Lin, Shih-Fan; Williams, Christine B.; Madanat, Hala; Jun, Hee-Jin; Zive, Michelle
Evidence indicates that restaurant-based interventions have the potential to promote healthier purchasing and improve the nutrients consumed. This study adds to this body of research by reporting the results of a trial focused on promoting the sale of healthy child menu items in independently owned restaurants. Eight pair-matched restaurants that met the eligibility criteria were randomized to a menu-only versus a menu-plus intervention condition. Both of the conditions implemented new healthy child menu items and received support for implementation for eight weeks. The menu-plus condition also conducted a marketing campaign involving employee trainings and promotional materials. Process evaluation data captured intervention implementation. Sales of new and existing child menu items were tracked for 16 weeks. Results indicated that the interventions were implemented with moderate to high fidelity depending on the component. Sales of new healthy child menu items occurred immediately, but decreased during the post-intervention period in both conditions. Sales of existing child menu items demonstrated a time by condition effect with restaurants in the menu-plus condition observing significant decreases and menu-only restaurants observing significant increases in sales of existing child menu items. Additional efforts are needed to inform sustainable methods for improving access to healthy foods and beverages in restaurants. PMID:29194392
Wise, Nancy J
Healthy eating among pregnant adolescents is essential for the well-being of developing adolescent females and their fetuses, as well as for the prevention of adult chronic illness. Understanding factors that influence and prohibit healthy eating, along with preferences for nutrition education in the pregnant adolescent population, is critical when designing and implementing appropriate nutrition education programs. The purpose of this study was to collect individual viewpoints of pregnant adolescents to facilitate the development of a nutrition intervention. This qualitative study using focus group methodology was conducted among pregnant adolescents. Participants (N = 14) were recruited through and teen parenting programs in the Mid-Atlantic region. Focus groups were guided by 6 open-ended questions that were developed based on implications from a previous study that surveyed eating habits of pregnant adolescents. Data were analyzed and coded using verbatim transcripts. Transcripts were read carefully for overall content and identification of major categories and then compared for similar and contrasting data. Four recurring themes emerged that described beliefs about healthy eating, influences on food choices, and nutrition education preferences: 1) pregnant adolescents demonstrate overall knowledge of healthy foods but are unwilling to give up unhealthy foods; 2) parents, offspring, and pregnancy influence healthy eating habits; 3) pregnant adolescents choose foods based on appearance and taste, cravings, convenience, and cost; and 4) pregnancy alters eating habits. Nutrition education in this population should be peer- and adolescent-focused and incorporate preferred methods of learning and favored incentives. Pregnant adolescents are more likely to attend educational programs that are population-specific and peer-focused, and include incentives that make cooking easier, more convenient, and affordable. Program content should be available to potential
Hanson, Jessica D; Nelson, Morgan E; Jensen, Jamie L; Willman, Amy; Jacobs-Knight, Jacque; Ingersoll, Karen
Fetal alcohol spectrum disorders (FASD) comprise a continuum of lifelong outcomes in those born prenatally exposed to alcohol. Although studies have shown no differences in rates by race, FASD is of particular concern for American Indian communities. One tribally run prevention program is the Oglala Sioux Tribe (OST) CHOICES Program, which is modeled after the evidence-based CHOICES program that was focused on preconceptional prevention of alcohol-exposed pregnancy (AEP) by reducing risky drinking in women at risk for pregnancy and/or preventing unintended pregnancy. The OST CHOICES Program was made culturally appropriate for American Indian women and implemented with 3 communities, 2 on the reservation and 1 off. Data on drinking, sexual activity, and contraception use were collected at baseline and 3 and 6 months postintervention. Data were analyzed using descriptive statistics, 1-way analysis of variance, and a random intercept generalized estimating equation model. A total of 193 nonpregnant American Indian women enrolled in the OST CHOICES Program, and all were at risk for AEP because of binge drinking and being at risk for an unintended pregnancy. Fifty-one percent of participants completed both 3- and 6-month follow-ups. Models showed a significant decrease in AEP risk from baseline at both 3- and 6-month follow-ups, indicating the significant impact of the OST CHOICES intervention. Women in the OST CHOICES Program were more likely to reduce their risk for AEP by utilizing contraception, rather than decreasing binge drinking. Even with minor changes to make the CHOICES intervention culturally and linguistically appropriate and the potential threats to program validity those changes entail, we found a significant impact in reducing AEP risk. This highlights the capacity for the CHOICES intervention to be implemented in a wide variety of settings and populations. Copyright © 2017 by the Research Society on Alcoholism.
Grabenhorst, Fabian; Schulte, Frank P; Maderwald, Stefan; Brand, Matthias
Food labeling is the major health policy strategy to counter rising obesity rates. Based on traditional economic theory, such strategies assume that detailed nutritional information will necessarily help individuals make better, healthier choices. However, in contrast to the well-known utility of labels in food marketing, evidence for the efficacy of nutritional labeling is mixed. Psychological and behavioral economic theories suggest that successful marketing strategies activate automatic decision biases and emotions, which involve implicit emotional brain systems. Accordingly, simple, intuitive food labels that engage these neural systems could represent a promising approach for promoting healthier choices. Here we used functional MRI to investigate this possibility. Healthy, mildly hungry subjects performed a food evaluation task and a food choice task. The main experimental manipulation was to pair identical foods with simple labels that emphasized either taste benefits or health-related food properties. We found that such labels biased food evaluations in the amygdala, a core emotional brain system. When labels biased the amygdala's evaluations towards health-related food properties, the strength of this bias predicted behavioral shifts towards healthier choices. At the time of decision-making, amygdala activity encoded key decision variables, potentially reflecting active amygdala participation in food choice. Our findings underscore the potential utility of food labeling in health policy and indicate a principal role for emotional brain systems when labels guide food choices. Copyright © 2013 Elsevier Inc. All rights reserved.
Froehlich Chow, Amanda; Leis, Anne; Humbert, Louise; Muhajarine, Nazeem; Engler-Stringer, Rachel
In order to improve healthy behaviours among rural children in their early years, a physical activity and healthy eating intervention (Healthy Start - Départ Santé) was implemented in rural childcare centres throughout Saskatchewan. The objective of the current study was to evaluate the impact of a multimodal physical activity and healthy eating intervention on educators' provision of opportunities for children to improve their physical activity levels, fundamental movement skills and healthy eating behaviours. Six childcare centres (three Francophone and three Anglophone) located in five different rural and semi-rural communities in Saskatchewan participated in this intervention. A total of 69 children with a mean age of 4 years 9 months, and 19 female early childhood educators. Guided by an ecological framework, we implemented a population health controlled intervention, using a wait list control design (48 weeks delayed intervention), and evaluated its impact in rural childcare centres. Mixed methods were employed to determine the effectiveness of the intervention. Overall, educators felt that the intervention supported the provision of physical activity and healthy eating opportunities for children. Increases in children's physical activity levels were reported following the intervention. The lessons learned in this study can be used to improve the Healthy Start - Départ Santé intervention so that its implementation can be effectively expanded to childcare centres within and outside Saskatchewan, in turn, supporting the healthy development of early years (0-5) children in the province and beyond.
de Droog, S.M.
Worldwide the number of overweight children rises dramatically. One way to prevent overweight is by creating healthy eating habits from a very young age. This dissertation explores whether and how 4- to 6-year-olds’ fruit and vegetable choices can be stimulated by using an immensely popular
Full Text Available BackgroundHomeless adults frequently experience poor nutrition. Research suggests raising self-efficacy and nutritional knowledge can increase healthy eating but that the choice of specific behavioral change techniques (BCTs is also critical. This study investigated how BCTs, operationalized to increase nutrition knowledge and self-efficacy, might influence the choice of homeless adults when presented with a “healthy” and an “unhealthy” snack.MethodsA total of 125 homeless adults were randomly allocated to watch 1 of 4 brief films: “control,” “[nutrition] information only,” “self-efficacy” (aimed at increasing self-efficacy and general healthy eating knowledge, and “enhanced self-efficacy” (as “self-efficacy,” but the presenter identified themselves as a homeless adult. Post-film, participants were invited to choose between a healthy and an unhealthy snack. Data were analyzed using ANOVA and chi square.ResultsParticipants in the “enhanced self-efficacy” condition were significantly more likely to choose the healthy option compared to those in the control condition; for the “self-efficacy” condition, the difference was marginally significant. Perceived knowledge and self-efficacy were significantly associated and those with high self-efficacy were significantly more likely to choose a healthy snack regardless of condition.ConclusionHomeless adults are more likely to make healthy snack choices if their nutritional self-efficacy is increased through encouragement by a peer.
Full Text Available Abstract Background Choosing cost-effective strategies for improving the health of the public is difficult because the relative effects of different types of interventions are not well understood. The benefits of one-shot interventions may be different from the benefits of interventions that permanently change the probability of getting sick, recovering, or dying. Here, we compare the benefits of such types of public health interventions. Methods We used multi-state life table methods to estimate the impact of five types of interventions on mortality, morbidity (years of life in fair or poor health, and years of healthy life (years in excellent, very good, or good health. Results A one-shot intervention that makes all the sick persons healthy at baseline would increase life expectancy by 3 months and increase years of healthy life by 6 months, in a cohort beginning at age 65. An equivalent amount of improvement can be obtained from an intervention that either decreases the probability of getting sick each year by 12%, increases the probability of a sick person recovering by 16%, decreases the probability that a sick person dies by 15%, or decreases the probability that a healthy person dies by 14%. Interventions aimed at keeping persons healthy increased longevity and years of healthy life, while decreasing morbidity and medical expenditures. Interventions focused on preventing mortality had a greater effect on longevity, but had higher future morbidity and medical expenditures. Results differed for older and younger cohorts and depended on the value to society of an additional year of sick life. Conclusion Interventions that promote health and prevent disease performed well, but other types of intervention were sometimes better. The value to society of interventions that increase longevity but also increase morbidity needs further research. More comprehensive screening and treatment of new Medicare enrollees might improve their health and
Bessems Kathelijne MHH
Full Text Available Abstract Background Krachtvoer is a Dutch healthy diet programme for prevocational schools, developed in 2001 and revised for a broader target group in 2007, based on the findings of an evaluation of the first version. The goal of this study was to report on the short- and longer-term total and subgroup effects of the revised programme on students’ fruit, fruit juice, breakfast, and snack consumption. Methods Schools were randomized to the experimental condition, teaching the Krachtvoer programme, or to the control condition teaching the regular nutrition lessons. Self-reported consumption of fruit, fruit juice, breakfast and snacks was measured at baseline directly before programme implementation, one to four weeks after finishing programme implementation, and after six months. Mixed linear and logistic regression analyses were conducted. Results In total 1117 students of 13 experimental schools and 758 students of 11 control schools participated in the study. Short- and longer-term favourable intervention effects were found on fruit consumption (mean difference between experimental and control group 0.15 servings at both posttests. Regarding fruit juice consumption, only short-term favourable effects were revealed (mean difference between experimental and control group 0.05 glasses. Intervention effects on breakfast intakes were limited. No changes in snack frequency were reported, but students made healthier snack choices as a result of the programme. Some favourable as well as unfavourable effects occurred in subgroups of students. Conclusions The effects on fruit consumption and snack choices justify the current nationwide dissemination of the programme. Achieving changes in breakfast consumption may, however, require other strategies.
Gittelsohn, Joel; Song, Hee-Jung; Suratkar, Sonali; Kumar, Mohan B; Henry, Elizabeth G; Sharma, Sangita; Mattingly, Megan; Anliker, Jean A
Obesity and other diet-related chronic diseases are more prevalent in low-income urban areas, which commonly have limited access to healthy foods. The authors implemented an intervention trial in nine food stores, including two supermarkets and seven corner stores, in a low-income, predominantly African American area of Baltimore City, with a comparison group of eight stores in another low-income area of the city. The intervention (Baltimore Healthy Stores; BHS) included an environmental component to increase stocks of more nutritious foods and provided point-of-purchase promotions including signage for healthy choices and interactive nutrition education sessions. Using pre- and postassessments, the authors evaluated the impact of the program on 84 respondents sampled from the intervention and comparison areas. Exposure to intervention materials was modest in the intervention area, and overall healthy food purchasing scores, food knowledge, and self-efficacy did not show significant improvements associated with intervention status. However, based on adjusted multivariate regression results, the BHS program had a positive impact on healthfulness of food preparation methods and showed a trend toward improved intentions to make healthy food choices. Respondents in the intervention areas were significantly more likely to report purchasing promoted foods because of the presence of a BHS shelf label. This is the first food store intervention trial in low-income urban communities to show positive impacts at the consumer level.
Sari, Nazmi; Muhajarine, Nazeem; Froehlich Chow, Amanda
Participation in daily physical activity and consuming a balanced diet high in fruits and vegetables and low in processed foods are behaviours associated with positive health outcomes during all stages of life. Previous literature suggests that the earlier these behaviours are established the greater the health benefits. As such, early learning settings have been shown to provide an effective avenue for exploring and influencing the physical activity and healthy eating behaviours of children before school entry. However, in addition to improving individual level health of children, such interventions may also result in a number of social benefits for the society. In fact, research among adult populations has shown that sufficient participation in physical activity can significantly lower hospital stays and physician visits, in turn leading to positive economic outcomes. To our knowledge there is very limited literature about economic evaluations of interventions implemented in early learning centers to increase physical activity and healthy eating behaviours among children. The primary purpose of this paper is to identify inputs and costs needed to implement a physical activity and healthy eating intervention (Healthy Start-Départ Santé (HS-DS)) in early learning centres throughout Saskatchewan and New Brunswick over the course of three years. In doing so, implementation cost is estimated to complete the first phase of a social return on investment analysis of this intervention. In order to carry out this evaluation the first step was to identify the inputs and costs needed to implement the intervention, along with the corresponding outputs. With stakeholder interviews and using existing database, we estimated the implementation cost by measuring, valuing and monetizing each individual input. Our results show that the total annual cost of implementing HS-DS was $378,753 in the first year, this total cost decreased slightly in the second year ($356,861) and again
Priest, Naomi; Armstrong, Rebecca; Doyle, Jodie; Waters, Elizabeth
Sporting organisations provide an important setting for health promotion strategies that involve policies, communication of healthy messages and creation of health promoting environments. The introduction of policy interventions within sporting organisations is one strategy to target high risk behaviours such as smoking, alcohol consumption, excess sun exposure, unhealthy eating and discrimination. To update a review of all controlled studies evaluating policy interventions organised through sporting settings to increase healthy behaviour (related to smoking, alcohol, healthy eating, sun protection, discrimination, safety and access). We updated the original (2004) searches in May 2007. We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2 2007); MEDLINE and MEDLINE In-Process and Other Non-Indexed Citations (2004 to Week 3 April 2007); EMBASE (2004 to Week 17 2007); PsyclNFO (2004 to April Week 1 2007); CINAHL (2004 to Week 1 May 2007); SPORTDiscus (2004 to April 2007); Sociological Abstracts (2004 to 2007); Dissertation Abstracts (2004 to May 2007), ERIC (2000 to 2007), freely available online health promotion and sports-related databases hosted by leading agencies, and the internet using sport and policy-related key words. Controlled studies evaluating any policy intervention implemented through sporting organisations to instigate and/or sustain healthy behaviour change, intention to change behaviour, or changes in attitudes, knowledge or awareness of healthy behaviour, in people of all ages. Policies must address any of the following: smoking, alcohol, healthy eating, sun protection, access for disadvantaged groups, physical safety (not including injuries), and social and emotional health (e.g. anti-vilification, anti-discrimination). Uncontrolled studies which met the other inclusion criteria were to be reported in an annex to the review. We assessed whether identified citations met the inclusion criteria
Souza, Evanice Avelino de; Barbosa Filho, Valter Cordeiro; Nogueira, Júlia Aparecida Devidé; Azevedo Júnior, Mario Renato de
This article provides a systematic literature review on physical activity and/or healthy eating interventions among Brazilian students. Complete articles published from 2004 to 2009 were searched in the SciELO, MEDLINE, and CAPES electronic databases, in the articles' references, and through contacts with authors. Six studies covered nutritional interventions, another six analyzed nutrition and physical activity, and one discussed changes in body composition. Interventions produced different results according to their objectives: increase in weekly physical activity; improvement in eating habits and knowledge on nutrition; and decrease in overweight and obesity. School health promotion programs are essential for raising awareness on the relevance of health promotion and the adoption of healthy habits. However, further longitudinal studies are needed to produce evidence on sustainability of programs and healthy habits.
Appelhans, Bradley M; French, Simone A; Olinger, Tamara; Bogucki, Michael; Janssen, Imke; Avery-Mamer, Elizabeth F; Powell, Lisa M
Delay discounting, the tendency to choose smaller immediate rewards over larger delayed rewards, is theorized to promote consumption of immediately rewarding but unhealthy foods at the expense of long-term weight maintenance and nutritional health. An untested implication of delay discounting models of decision-making is that selectively delaying access to less healthy foods may promote selection of healthier (immediately available) alternatives, even if they may be less desirable. The current study tested this hypothesis by measuring healthy versus regular vending machine snack purchasing before and during the implementation of a 25-s time delay on the delivery of regular snacks. Purchasing was also examined under a $0.25 discount on healthy snacks, a $0.25 tax on regular snacks, and the combination of both pricing interventions with the 25-s time delay. Across 32,019 vending sales from three separate vending locations, the 25-s time delay increased healthy snack purchasing from 40.1% to 42.5%, which was comparable to the impact of a $0.25 discount (43.0%). Combining the delay and the discount had a roughly additive effect (46.0%). However, the strongest effects were seen under the $0.25 tax on regular snacks (53.7%) and the combination of the delay and the tax (50.2%). Intervention effects varied substantially between vending locations. Importantly, time delays did not harm overall vending sales or revenue, which is relevant to the real-world feasibility of this intervention. More investigation is needed to better understand how the impact of time delays on food choice varies across populations, evaluate the effects of time delays on beverage vending choices, and extend this approach to food choices in contexts other than vending machines. ClinicalTrials.gov, NCT02359916. Copyright © 2018 Elsevier Ltd. All rights reserved.
Volpe Stella L
Full Text Available Abstract Background The HEALTHY study was designed to respond to the alarming trends in increasing rates of overweight, obesity, and type 2 diabetes mellitus in youth. The objective of this analysis was to examine the effects of the HEALTHY study on student self-reported dietary intakes (energy, macronutrients and grams consumed of selected food groups. Methods HEALTHY was a cluster-randomized study in 42 public middle schools. Students, n = 3908, self-reported dietary intake using the Block Kids Questionnaire. General linear mixed models were used to analyze differences in dietary intake at the end of the study between intervention and control schools. Results The reported average daily fruit consumption was 10% higher at the end of the study in the intervention schools than in the control schools (138 g or approximately 2 servings versus 122 g, respectively, p = 0.0016. The reported water intake was approximately 2 fluid ounces higher in the intervention schools than in the control (483 g versus 429 g respectively; p = 0.008. There were no significant differences between intervention and control for mean intakes of energy, macronutrients, fiber, grains, vegetables, legumes, sweets, sweetened beverages, and higher- or lower-fat milk consumption. Conclusion The HEALTHY study, a five-semester middle school-based intervention program that integrated multiple components in nutrition, physical education, behavior change, and social marketing-based communications, resulted in significant changes to student's reported fruit and water intake. Subsequent interventions need to go beyond the school environment to change diet behaviors that may affect weight status of children. Clinical Trials Registration NCT00458029
Ares, Gastón; Gámbaro, Adriana
The aims of the present study were to study the effect of different carriers and enrichments on the perceived healthiness and willingness to try functional foods; and to evaluate the effect of age, gender and motives underlying food choice. Participants had to evaluate different functional food concepts and had to answer a food choice questionnaire. Results showed that carrier products had the largest effect on consumers' perception of healthiness and willingness to try of the evaluated functional foods concepts. The highest positive relative utilities were achieved when the enrichment was a functional ingredient inherent in the product. Furthermore, gender, age and motives underlying food choice affected the preference patterns for the evaluated functional foods concepts, but it depended on the carrier and enrichment considered, suggesting that functional foods might not be accepted by all the consumers and that they could be tailored for certain groups.
O'Brien, Orna A; Lindsay, Karen L; McCarthy, Mary; McGloin, Aileen F; Kennelly, Maria; Scully, Helena A; McAuliffe, Fionnuala M
to qualitatively explore influences identified by overweight/obese pregnant women on food choices and physical activity (PA) behaviours; to determine the impact of pregnancy on these factors; and to inform development of future lifestyle interventions during pregnancy. cross-sectional interview study. maternity hospital, Ireland. pregnant women (n=22), early pregnancy Body Mass Index > 25kg/m 2 MEASURES: barriers to and facilitators of healthy eating and PA in overweight/obese pregnancy. Interviews were transcribed verbatim and analysed using inductive thematic analysis. overweight/obese women perceived the following factors to influence their food choices and PA behaviours: personal (e.g. age, enjoyment, health, aesthetic appearance, and response to fatigue); social (e.g. social support, food modelling, social facilitation and weight bias) and environmental (e.g. food salience and the obesogenic environment). These factors affected PA and food choice trajectories differently according to socio-economic and socio-cultural context. personal, social and environmental factors affect food choices and PA behaviours. Pregnancy is a powerful stimulus for positive changes in food choices particularly. This change is driven by desire for healthy pregnancy outcome, and is not intrinsically motivated. Healthy lifestyle interventions should aim to sustain positive changes beyond pregnancy through: empowerment, intrinsic motivation, family-centred approach, and behavioural goals. Copyright © 2017. Published by Elsevier Ltd.
Naughton, Paul; McCarthy, Sinéad N; McCarthy, Mary B
This study aimed to develop a healthy eating motivation score and to determine if dietary, lifestyle and activity behaviours vary across levels of motivation to eat a healthy diet with a view to informing health promotion interventions. A cross-sectional survey of food intake, physical activity, lifestyles and food choice attitudes was conducted in a nationally representative sample of 1262 adults in the Republic of Ireland aged 18 years and over. Increasing score for health motivation was significantly and positively related to healthy eating and exercise. Women, increasing age, normal BMI, regular exercise and increasing intakes of fruit and vegetables were associated with a higher odds ratio (OR) for having a high healthy eating motivation score. However, despite a high motivation score only 31% of consumers in the strong motivation group achieved the recommendations for daily fruit and vegetable consumption, while 57% achieved the fat recommendation. A higher intake of calorie dense foods from the top shelf of the food pyramid and increased time spent watching T.V. was associated with a decreased OR for positive motivation towards healthy eating. Healthy eating promotions directed at women and older adults should focus on supporting people's motivations to attain a healthy diet by addressing issues such as dietary self-control and self-regulation. For men and younger adults, healthy eating promotions will need to address the issues underlying their weak attitudes towards healthy eating.
Meinen, Amy M.; Nitzke, Susan A.; Martinez-Donate, Ana P.
Introduction Increasingly high rates of obesity have heightened interest among researchers and practitioners in identifying evidence-based interventions to increase access to healthful foods and beverages. Because most food purchasing decisions are made in food stores, such settings are optimal for interventions aimed at influencing these decisions. The objective of this review was to synthesize the evidence on supermarket and grocery store interventions to promote healthful food choices. Methods We searched PubMed through July 2012 to identify original research articles evaluating supermarket and grocery store interventions that promoted healthful food choices. We categorized each intervention by type of intervention strategy and extracted and summarized data on each intervention. We developed a scoring system for evaluating each intervention and assigned points for study design, effectiveness, reach, and availability of evidence. We averaged points for each intervention category and compared the strength of the evidence for each category. Results We identified 58 articles and characterized 33 interventions. We found 7 strategies used alone or in combination. The most frequently used strategy was the combination of point-of-purchase and promotion and advertising (15 interventions); evidence for this category was scored as sufficient. On average, of 3 points possible, the intervention categories scored 2.6 for study design, 1.1 for effectiveness, 0.3 for reach, and 2 for availability of evidence. Three categories showed sufficient evidence; 4 showed insufficient evidence; none showed strong evidence. Conclusion More rigorous testing of interventions aimed at improving food and beverage choices in food stores, including their effect on diet and health outcomes, is needed. PMID:23578398
Sweeney, Jennifer K.; Villarejo, Merna
This qualitative, retrospective study explored how educational experiences provided as part of an undergraduate intervention program helped to shape career decisions for minority biology students. A key goal for the program is to increase minority entry into science research and teaching careers, yet actual career choice has not been studied.…
Piana, Natalia; Ranucci, Claudia; Buratta, Livia; Foglia, Elena; Fabi, Marta; Novelli, Francesca; Casucci, Simone; Reginato, Elisa; Pippi, Roberto; Aiello, Cristina; Leonardi, Alessia; Romani, Giannermete; De Feo, Pierpaolo; Mazzeschi, Claudia
Objective: To describe an innovative school-based intervention to promote healthy lifestyles. To evaluate its effects on children's food habits and to highlight the key components which contribute most to the beneficial effects obtained from children's, teachers' and parents' perspectives. Design: An educational tool to improve personal awareness,…
The HEALTHY study was a randomized, controlled, multicenter, middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth gr...
Full Text Available OBJECTIVE: To present a Diet Quality Index proper for dietary intake studies of Brazilian adults. METHODS: A diet quality index to analyze the incorporation of healthy food choices was associated with a digital food guide. This index includes moderation components, destined to indicate foods that may represent a risk when in excess, and adequacy components that include sources of nutrients and bioactive compounds in order to help individuals meet their nutritional requirements. The diet quality index-digital food guide performance was measured by determining its psychometric properties, namely content and construct validity, as well as internal consistency. RESULTS: The moderation and adequacy components correlated weakly with dietary energy (-0.16 to 0.09. The strongest correlation (0.52 occurred between the component 'sugars and sweets' and the total score. The Cronbach's coefficient alpha for reliability was 0.36. CONCLUSION: Given that diet quality is a complex and multidimensional construct, the Diet Quality Index-Digital Food Guide, whose validity is comparable to those of other indices, is a useful resource for Brazilian dietary studies. However, new studies can provide additional information to improve its reliability.
Full Text Available Abstract Background Eating a diet that is high in fat and sugar and having a sedentary lifestyle during pregnancy is understood to increase the risk of excessive gestational weight gain and obesity following the birth of the baby. However, there are no clinical guidelines in the UK on what is considered to be appropriate gestational weight gain. Indeed, clinical recommendations discourage the routine re-weighing of pregnant women, stating instead that women should be advised regarding their diet and activity levels, in order to prevent excessive weight gain. Pregnancy is seen as a time when many women may have an increased motivation to improve their lifestyle behaviours for the benefit of the fetus. However, it is evident that many women have difficulty in both maintaining a healthy balanced diet and remaining active through pregnancy. It would seem that midwives may be ideally placed to assist women to make and maintain healthier lifestyle choices during pregnancy. Methods/design This study will look at the feasibility and acceptability of a newly devised intervention programme called 'Eat Well Keep Active'. Participants will complete a questionnaire prior to the programme to obtain baseline data on food frequency, physical activity and to gauge their perception of personal ability to improve/maintain healthy lifestyle. The programme comprises client centred techniques; motivational interviewing and goal setting delivered early in pregnancy (12-16 weeks with the aim of supporting a healthy well balanced diet and either continuing or commencing appropriate levels of physical activity. Participants will then be followed up six weeks following the intervention with a one-to-one interview, and a further brief questionnaire. The interview will provide preliminary data regarding perceived effectiveness and acceptability of the 'Eat Well Keep Active' programme whilst the questionnaire will provide data regarding changes in the confidence of
Warren, Lucie; Rance, Jaynie; Hunter, Billie
Eating a diet that is high in fat and sugar and having a sedentary lifestyle during pregnancy is understood to increase the risk of excessive gestational weight gain and obesity following the birth of the baby. However, there are no clinical guidelines in the UK on what is considered to be appropriate gestational weight gain. Indeed, clinical recommendations discourage the routine re-weighing of pregnant women, stating instead that women should be advised regarding their diet and activity levels, in order to prevent excessive weight gain. Pregnancy is seen as a time when many women may have an increased motivation to improve their lifestyle behaviours for the benefit of the fetus. However, it is evident that many women have difficulty in both maintaining a healthy balanced diet and remaining active through pregnancy. It would seem that midwives may be ideally placed to assist women to make and maintain healthier lifestyle choices during pregnancy. This study will look at the feasibility and acceptability of a newly devised intervention programme called 'Eat Well Keep Active'. Participants will complete a questionnaire prior to the programme to obtain baseline data on food frequency, physical activity and to gauge their perception of personal ability to improve/maintain healthy lifestyle. The programme comprises client centred techniques; motivational interviewing and goal setting delivered early in pregnancy (12-16 weeks) with the aim of supporting a healthy well balanced diet and either continuing or commencing appropriate levels of physical activity. Participants will then be followed up six weeks following the intervention with a one-to-one interview, and a further brief questionnaire. The interview will provide preliminary data regarding perceived effectiveness and acceptability of the 'Eat Well Keep Active' programme whilst the questionnaire will provide data regarding changes in the confidence of participants to lead a healthy lifestyle. There is an
Finderup, Jeanette; Jensen, Jens Dam; Lomborg, Kirsten
. Nevertheless, studies have shown lack of involvement of the patient in decision-making. Objectives: To develop and pilot test an intervention for shared decision-making targeting the choice of dialysis modality. Methods: This study reflects the first two phases of a complex intervention design: phase 1......, the development process and phase 2, feasibility and piloting. Because decision aids were a part of the intervention, the International Patient Decision Aid Standards were considered. The pilot test included both the intervention and the feasibility of the validated shared decision-making questionnaire (SDM Q9......) and the Decision Quality Measure (DQM) applied to evaluate the intervention. Results: A total of 137 patients tested the intervention. After the intervention, 80% of the patients chose dialysis at home reflecting an increase of 23% in starting dialysis at home prior to the study. The SDM Q9 showed the majority...
Nørnberg, Trine R; Houlby, Louise; Skov, Laurits Rohden; Perez-Cueto, Armando
Aims: The primary objective of this review is to assess the prevalence and quality of published studies on the effect of choice architectural nudge interventions promoting vegetable consumption among adolescents. Additionally, this review aims to identify studies estimating adolescents’ attitude towards choice architectural nudge interventions.Methods: Web of Science, Scopus and PubMed were searched systematically for experimental studies with a predefined search strategy in the period Novemb...
Himes, Katherine Park; Donovan, Heidi; Wang, Stephanie; Weaver, Carrie; Grove, Jillian Rae; Facco, Francesca Lucia
During the postpartum visit, health care providers address issues with short- and long-term implications for maternal and child health. Women with Medicaid insurance are less likely to return for a postpartum visit compared with women with private insurance. Behavioral economics acknowledges that people do not make exclusively rational choices, rather immediate gratification, cognitive and psychological biases, and social norms influence decision making. Drawing on insights from decision science, behavioral economists have examined how these biases can be modulated through carefully designed interventions. We have developed a Web-based tool, Healthy Beyond Pregnancy, that incorporates empirically derived concepts of behavioral economics to improve adherence rates to the postpartum visit. The primary objectives of this pilot study were to (1) refine and assess the usability of Healthy Beyond Pregnancy and (2) assess the feasibility of a randomized controlled trial (RCT) of the intervention. We used a multistep process and multidisciplinary team of maternal-fetal medicine physicians, a behavioral economist, and researchers with expertise in behavioral interventions to design Healthy Beyond Pregnancy. We assessed the usability of the program with the Post-Study System Usability Questionnaire (PSSUQ), a validated 7-point scale, and semistructured interviews with postpartum women. We then conducted a feasibility trial to determine the proportion of eligible women who were willing to participate in an RCT of Healthy Beyond Pregnancy and the proportion of women willing to complete the Web-based program. Exploratory outcomes of the pilot trial included attendance at the postpartum visit, uptake of long-acting reversible contraception, and uptake of any contraception. The median PSSUQ score for Healthy Beyond Pregnancy was 6.5 (interquartile range: 6.1-7) demonstrating high usability. Semistructured interviews (n=10) provided in-depth comments about users' experience and
Thayer, Linden M.; Pimentel, Daniela C.; Smith, Janice C.; Garcia, Beverly A.; Sylvester, Laura Lee; Kelly, Tammy; Johnston, Larry F.; Ammerman, Alice S.; Keyserling, Thomas C.
Background: Because Americans commonly consume restaurant foods with poor dietary quality, effective interventions are needed to improve food choices at restaurants. Purpose: The purpose of this study was to design and evaluate a restaurant-based intervention to help customers select and restaurants promote heart healthy menu items with healthful…
Bucher, Tamara; Collins, Clare; Rollo, Megan E; McCaffrey, Tracy A; De Vlieger, Nienke; Van der Bend, Daphne; Truby, Helen; Perez-Cueto, Federico J A
Nudging or 'choice architecture' refers to strategic changes in the environment that are anticipated to alter people's behaviour in a predictable way, without forbidding any options or significantly changing their economic incentives. Nudging strategies may be used to promote healthy eating behaviour. However, to date, the scientific evidence has not been systematically reviewed to enable practitioners and policymakers to implement, or argue for the implementation of, specific measures to support nudging strategies. This systematic review investigated the effect of positional changes of food placement on food choice. In total, seven scientific databases were searched using relevant keywords to identify interventions that manipulated food position (proximity or order) to generate a change in food selection, sales or consumption, among normal-weight or overweight individuals across any age group. From 2576 identified articles, fifteen articles comprising eighteen studies met our inclusion criteria. This review has identified that manipulation of food product order or proximity can influence food choice. Such approaches offer promise in terms of impacting on consumer behaviour. However, there is a need for high-quality studies that quantify the magnitude of positional effects on food choice in conjunction with measuring the impact on food intake, particularly in the longer term. Future studies should use outcome measures such as change in grams of food consumed or energy intake to quantify the impact on dietary intake and potential impacts on nutrition-related health. Research is also needed to evaluate potential compensatory behaviours secondary to such interventions.
Pot, G.K.; Richards, M.; Prynne, C.J.; Stephen, AM
Objective Current indices of diet quality generally include intakes of specific foods or nutrients. We sought to develop an index that discriminates healthy and unhealthy eating choices for use in large surveys as a short questionnaire and as a measure in existing studies with adequate dietary data.
Pittman, D W; Parker, J S; Getz, B R; Jackson, C M; Le, T-A P; Riggs, S B; Shay, J M
We aimed to develop a cost-free and sustainable program to influence healthier eating decisions during elementary school lunch. Baseline food and beverage choices were assessed for 9 days during lunch service at two racially and economically diverse elementary schools in Spartanburg County, SC, USA. After being informed that the labeled items on the daily lunch menu represented the healthiest choice, students were allowed to ring a call bell in the cafeteria for public recognition when they chose all of the identified healthiest food and beverage items during lunch service. Using menus matched to the baseline phase, food and beverage choices were measured during a 9-day intervention phase. After 30 days, food and beverage choices were reassessed during a 3-day follow-up phase. Healthiest food & beverage choices increased 49% with >60% of students choosing non-flavored milk over flavored milk during the intervention phase. There was no difference in the success of the program between the two schools. The program continued and healthy eating decisions were significantly sustained at a 30-day follow-up assessment. Public recognition through bell ringing appears to be an effective practice to sustain increases in healthy eating decisions during elementary school lunch and warrants expansion to larger scale, longitudinal trials.
Gregory R Samanez-Larkin
Full Text Available Intertemporal choices are a ubiquitous class of decisions that involve selecting between outcomes available at different times in the future. We investigated the neural systems supporting intertemporal decisions in healthy younger and older adults. Using functional neuroimaging, we find that aging is associated with a shift in the brain areas that respond to delayed rewards. Although we replicate findings that brain regions associated with the mesolimbic dopamine system respond preferentially to immediate rewards, we find a separate region in the ventral striatum with very modest time dependence in older adults. Activation in this striatal region was relatively insensitive to delay in older but not younger adults. Since the dopamine system is believed to support associative learning about future rewards over time, our observed transfer of function may be due to greater experience with delayed rewards as people age. Identifying differences in the neural systems underlying these decisions may contribute to a more comprehensive model of age-related change in intertemporal choice.
Mudd-Martin, Gia; Martinez, Maria C; Rayens, Mary Kay; Gokun, Yevgeniya; Meininger, Janet C
Suboptimal lifestyle factors in combination with genetic susceptibility contribute to cardiovascular disease and type 2 diabetes risk among Latinos. We describe a community-academic collaboration that developed and explored the feasibility of implementing a socioculturally tailored, healthy lifestyle intervention integrating genomics and family history education to reduce risk of cardiovascular disease and type 2 diabetes among Latinos. The community-based participatory research was conducted with communities in Kentucky, which has a rapidly growing Latino population. This growth underscores the need for socioculturally appropriate health resources. Su Corazon, Su Vida (Your Heart, Your Life) is a Spanish-language, healthy lifestyle educational program to reduce cardiovascular disease and type 2 diabetes risk among Latinos. Twenty natural leaders from an urban Latino community in Kentucky participated in sociocultural tailoring of the program and development of a genomics and family history module. The tailored program was presented to 22 participants to explore implementation feasibility and assess appropriateness for community use. Preintervention and postintervention assessments of genomic knowledge and lifestyle behaviors and qualitative postintervention evaluations were conducted. Postintervention improvements in health-promoting lifestyle choices and genomic knowledge specific to cardiovascular disease and type 2 diabetes suggested that the program may be effective in reducing risk. Feedback indicated the program was socioculturally acceptable and responsive to community needs. These findings indicated that a tailored healthy lifestyle program integrating genomics and family history education was socioculturally appropriate and may feasibly be implemented to reduce cardiovascular disease and type 2 diabetes risk in a Latino community with limited health care resources. The project highlights contributions of community-based processes in tailoring
Social network type might affect an individual's food choice because these decisions are often made as a group rather than individually. In this study, the associations between social network type, food choice value, and diet quality in frail older adults with low socioeconomic status were investigated. For this cross-sectional study, 87 frail older adults were recruited from the National Home Healthcare Services in Seoul, South Korea. Social network types, food choice values, and diet quality were assessed using The Practitioner Assessment of Network Type Instrument, The Food Choice Questionnaire, and mean adequacy ratio, respectively. Results showed that frail older adults with close relationships with local family and/or friends and neighbors were less likely to follow their own preferences, such as taste, price, and beliefs regarding food health values. In contrast, frail older adults with a small social network and few community contacts were more likely to be influenced by their food choice values, such as price or healthiness of food. Frail older adults who tend to choose familiar foods were associated with low-quality dietary intake, while older adults who valued healthiness or use of natural ingredients were associated with a high-quality diet. The strength and direction of these associations were dependent on social network type of frail older adults. This study explored the hypothesis that food choice values are associated with a certain type of social network and consequently affect diet quality. While additional research needs to be conducted, community-based intervention intended to improve diet quality of frail older adults must carefully consider individual food choice values as well as social network types. Copyright © 2015 Elsevier Ltd. All rights reserved.
Mitchell, Wendy A
Current western policy, including the UK, advocates choice for service users and their families, taking greater control and being more involved in decision making. However, children's role in health decision making, especially from their own perspective, has received less research attention compared to doctors and parents' perspectives. To explore the perspective and experiences of disabled young people with degenerative conditions as they face significant medical interventions and engage in decision-making processes. Findings from a longitudinal qualitative study of 10 young people (13-22 years) with degenerative conditions are reported. Individual semi-structured interviews were conducted with participants over 3 years (2007-2010); the paper reports data from all three interview rounds. Interviews focused on medical intervention choices the young people identified as significant. Although the young people in this study felt involved in the medical intervention choices discussed, findings demonstrate a complex and diverse picture of decision making. Results highlighted different decisional roles adopted by the young people, the importance of information heuristics and working with other people whilst engaging in complex processes weighing up different decisional factors. Young people's experiences demonstrate the importance of moving beyond viewing health choices as technical or rational decisions. How each young person framed their decision was important. Recognizing this diversity and the importance of emerging themes, such as living a normal life, independence, fear of decisions viewed as 'irreversible' and the role of parents and peers in decision making highlights that, there are clear practice implications including, active practitioner listening, sensitivity and continued holistic family working. © 2012 John Wiley & Sons Ltd.
Full Text Available Introduction: Continuing growth in human population and consumptionmeans that the global demand for food will increase for at least another 40 years and that the world needs 70-100% more food by 2050. Environmental issues such as climate change, depletion of naturalresources and biodiversity loss increasingly threaten the welfare ofhuman civilization. Confronting these threats requires, among otherthings, behavioral changes in citizens, governments and companies.Farmers and other producers are responding to consumer concerns about pesticides by creating new marketing opportunities for products grown with environmentally sound practices. Environmental economists are increasingly interested in better understanding of how people cognitively organize their beliefs and attitudes towards environmental change in order to identify key motives and barriers that stimulate or prevent action.The purpose of the presentinvestigation is to evaluate the consumers’ preferences and factors affecting their choice for conventional, healthy and organic cucumbers in Isfahan, Iran. Materials and Methods: Data were collected on a sample of 230consumers in 2013 by using the proportionate stratification samplingmethod through face-to-face interviews based on a comprehensive structured questionnaire. Before the survey, the reliability and validity of the questionnaire were initially evaluated in a pre-test study, respectively, by using Cronbach’s alpha coefficient and Kaiser-Meyer-Olkin (KMO criteria. Individual preferences were uncovered in choice experiment method (CEM by a contingent ranking experiment. In a contingent ranking experiment, respondents are required to rank a set of alternative options, characterized by a number of attributes, which are offered at different levels across the options.Data were analyzed by multinomial logit models. The approach consists of modeling utility, that isto say the net benefit a consumer obtains from selecting a
Hartmann, Christina; Siegrist, Michael; van der Horst, Klazine
We examined associations between snack frequency, sociodemographic characteristics, BMI, dietary and eating behaviour. In order to identify whether various subgroups of high-frequency snack consumers exist, we investigated underlying food patterns and lifestyle factors. The data were based on the Swiss Food Panel Questionnaire of 2010, which included an FFQ, questions relating to sociodemographics and lifestyle factors. Data were examined using ANOVA, regression analysis and hierarchical cluster analysis. Gender differences were also investigated in the analysis of the data. A sample of 6189 adults participating in the Swiss Food Panel filled in a questionnaire (response rate 30%). The sample consisted of both men and women, with a mean age of 54?4 (SD 13?5) years. There was no association between snack frequency and BMI. Consumption frequency of sweets and savouries as well as fruit intake increased with increasing snack frequency. Additionally, three different subgroups of high-frequency snack consumers could be revealed: healthy, moderate and unhealthy dietary-pattern groups. The latter included respondents who were less health-conscious and was characterized by high alcohol consumption frequency, daily breakfast skipping and watching television during the main meal. High snack frequency occurred in the context of healthy as well as unhealthy dietary behaviour and lifestyle patterns. Women made healthier dietary food choices and were more likely to consume fruits as snacks, while men chose unhealthy foods, such as sweets and savouries, more often.
Barak-Nahum, Ayelet; Haim, Limor Ben; Ginzburg, Karni
Previous studies have shown that the dietary habits of cancer patients and survivors have significant implications for their recovery and quality of life. The current study examined the effectiveness of an innovative culinary group intervention on cancer patients' quality of life through changes in their eating behaviors, as manifested by an increase in their tendency towards intuitive eating and healthy food choices. In total, 190 cancer patients participated in this study, and were allocated to an intervention or a wait-list control group. A battery of self-report questionnaires assessing food choices, intuitive eating, health-related quality of life, and subjective well-being was administered at two time points: Before the intervention (T1) and at the end of the three month intervention (T2). Analyses revealed an increase in health-related quality of life and well-being among the intervention group. Intuitive eating and healthy food choices also increased among the intervention but not wait-list control group. Finally, results indicated that participation in the culinary group intervention and improvements in health-related quality of life and well-being were mediated by changes in eating behaviors. Our findings demonstrate that nutrition and eating behaviors have a significant effect on cancer patients' physical and emotional adjustment. A culinary group intervention seems to target patients' physical and emotional needs and promote their adjustment. Copyright © 2016 Elsevier Ltd. All rights reserved.
Centis, E; Marzocchi, R; Di Luzio, R; Moscatiello, S; Salardi, S; Villanova, N; Marchesini, G
Overweight and obesity prevention in childhood and adolescence represent a priority for public health; school is a privileged place for health promotion interventions. The study aimed to test the effectiveness of a multicomponent 5-month intervention on the habits of primary school children, making the families aware of the importance of healthy choices. Two hundred nine children attending the fourth class of primary school, divided into interventional (n = 103) and control arm (n = 106) were included in the study. In the intervention group, parents and teachers received more intense lifestyle counseling, associated with weekly motivational telephone calls to families to motivate further their lifestyle changes. Standard deviation score (SDS) body mass index (BMI) was the primary outcome measure; on open-air games and TV watching were secondary outcomes. At baseline, no differences were observed between groups. At 8-month follow-up, mean SDS BMI had decreased by 0.06 units in the intervention arm and increased by 0.12 in controls (time × treatment anova, P < 0.002). Outdoor activities increased from 6.23 h week(-1) to 9.93 in the intervention group (P < 0.001), not in controls. This change was associated differences in TV watching from baseline (intervention, -0.96 h week(-1); P = 0.037; controls, +1.33 h week(-1); P = 0.031). A multicomponent school-based intervention addressing the needs of children, teachers and families produced a significant and favourable short-term effect on overweight/obese schoolchildren. © 2012 The Authors. Pediatric Obesity © 2012 International Association for the Study of Obesity.
Lee-Kwan, Seung Hee; Bleich, Sara N; Kim, Hyunju; Colantuoni, Elizabeth; Gittelsohn, Joel
To investigate how a pilot environmental intervention changed food sales patterns in carryout restaurants. Quasi-experimental. Low-income neighborhoods of Baltimore, Maryland. Seven carryouts (three intervention, four comparison). Phase 1, menu board revision and healthy menu labeling; phase 2, increase of healthy sides and beverages; and phase 3, promotion of cheaper and healthier combination meals. Weekly handwritten menu orders collected to assess changes in the proportion of units sold and revenue of healthy items (entrée, sides and beverages, and combined). Logistic and Poisson regression models with generalized estimating equations. In the intervention group, odds for healthy entrée units and odds for healthy side and beverage units sold significantly increased in phases 2 and 3; odds for healthy entrée revenue significantly increased in phase 1 (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08-1.26), phase 2 (OR 1.32, 95% CI 1.25-1.41), and phase 3 (OR 1.39, 95% CI 1.14-1.70); and odds for healthy side and beverage revenues increased significantly in phase 2 (OR 1.62, 95% CI 1.33-1.97) and phase 3 (OR 2.73, 95% CI 2.15-3.47) compared to baseline. Total revenue in the intervention group was significantly higher in all phases than in the comparison group (p selection, and competitive pricing can increase availability and sales of healthy items in carryouts.
Aschbrenner, Kelly; Bartels, Stephen; Mueser, Kim; Carpenter-Song, Elizabeth; Kinney, Allison
This focus group study explored the potential benefits and challenges of involving family members and significant others in a healthy lifestyle program for people with serious mental illness (SMI). Six focus group interviews were conducted with a total of 30 people with SMI, who were participants in a healthy lifestyle intervention. Separate focus…
Watson, Judith; Tober, Gillian; Raistrick, Duncan; Mdege, Noreen; Dale, Veronica; Crosby, Helen; Godfrey, Christine; Lloyd, Charlie; Toner, Paul; Parrott, Steve
Alcohol misuse is a major cause of premature mortality and ill health. Although there is a high prevalence of alcohol problems among patients presenting to general hospital, many of these people are not help seekers and do not engage in specialist treatment. Hospital admission is an opportunity to steer people towards specialist treatment, which can reduce health-care utilization and costs to the public sector and produce substantial individual health and social benefits. Alcohol misuse is associated with other lifestyle problems, which are amenable to intervention. It has been suggested that the development of a healthy or balanced lifestyle is potentially beneficial for reducing or abstaining from alcohol use, and relapse prevention. The aim of the study is to test whether or not the offer of a choice of health-related lifestyle interventions is more acceptable, and therefore able to engage more problem drinkers in treatment, than an alcohol-focused intervention. This is a pragmatic, randomized, controlled, open pilot study in a UK general hospital setting with concurrent economic evaluation and a qualitative component. Potential participants are those admitted to hospital with a diagnosis likely to be responsive to addiction interventions who score equal to or more than 16 on the Alcohol Use Disorders Identification Test (AUDIT). The main purpose of this pilot study is to evaluate the acceptability of two sorts of interventions (healthy living related versus alcohol focused) to the participants and to assess the components and processes of the design. Qualitative research will be undertaken to explore acceptability and the impact of the approach, assessment, recruitment and intervention on trial participants and non-participants. The effectiveness of the two treatments will be compared at 6 months using AUDIT scores as the primary outcome measure. There will be additional economic, qualitative and secondary outcome measurements. Development of the study was a
Griffith, Rachel; von Hinke, Stephanie; Smith, Sarah
There is growing policy interest in encouraging better dietary choices. We study a nationally-implemented policy - the UK Healthy Start scheme - that introduced vouchers for fruit, vegetables and milk. We show that the policy has increased spending on fruit and vegetables and has been more effective than an equivalent-value cash benefit. We also show that the policy improved the nutrient composition of households' shopping baskets, with no offsetting changes in spending on other foodstuffs. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.
Coughlin, Steven S; Hatzigeorgiou, Christos; Anglin, Judith; Xie, Ding; Besenyi, Gina M; De Leo, Gianluca; Stewart, Jessica; Wilkins, Thad
Diet and exercise therapy have been reported to be effective in improving blood glucose control and are an important part of treatment of type 2 diabetes mellitus. The goal of this study is to examine the efficacy of a healthy lifestyle intervention for adult clinic patients with type 2 diabetes mellitus, as measured by Hgb-A1c, cardiovascular indicators, physical activity, weight, and BMI. Also of interest are optimal strategies for subject recruitment, the number of intervention sessions attended, and participant use of the Fitbit watch to monitor their physical activity and track food and beverage consumption. A pre/post-test design will be used in this pilot study. Non-institutionalized adult patients (n=50) aged 18-65 years who have been seen at the Augusta Health outpatient clinics (General Internal Medicine or Family Medicine) for type 2 diabetes in the past 12 months, and who are interested in reducing their risk of disease recurrence through healthy lifestyle behaviors, will be eligible to participate. At orientation visit, eligible individuals will be asked to provide written informed consent. Consenting volunteers (n=50) will be asked to complete the baseline and 6-month follow-up questionnaire and to participate in 12 weekly group sessions of 90 min duration, involving physical activity and to meet with a dietitian (baseline, one month, 90 days) to receive individualized advice on diet and nutrition. The technology-based intervention will use wrist-worn Fitbit Blaze physical activity monitoring devices. This pilot study will provide important information about the feasibility and preliminary efficacy of a healthy lifestyle intervention for adult clinic patients with type 2 diabetes mellitus. The use of consumer-facing devices such as the Fitbit watch has the potential advantage over the use of research accelerometers, pedometers, or actigraphs in increasing the likelihood that the intervention will be sustainable after the study ends.
Mayén, Ana-Lucia; de Mestral, Carlos; Zamora, Gerardo; Paccaud, Fred; Marques-Vidal, Pedro; Bovet, Pascal; Stringhini, Silvia
Diet is a major risk factor for non-communicable diseases (NCDs) and is also strongly patterned by socioeconomic factors. Whether interventions promoting healthy eating reduce social inequalities in diet in low- and middle-income countries (LMICs) remains uncertain. This paper aims to summarize current evidence on interventions promoting healthy eating in LMICs, and to establish whether they reduce social inequalities in diet. Systematic review of cross-sectional or quasi-experimental studies (pre- and post-assessment of interventions) in Pubmed, Scielo and Google Scholar databases, including adults in LMICs, assessing at least one outcome of healthy eating and showing results stratified by socioeconomic status. Seven intervention studies including healthy eating promotion, conducted in seven LMICs (Brazil, Chile, Colombia, Iran, Panama, Trinidad and Tobago, and Tunisia), met our inclusion criteria. To promote healthy eating, all interventions used nutrition education and three of them combined nutrition education with improved acces to foods or social support. Interventions targeted mostly women and varied widely regarding communication tools and duration of the nutrition education sessions. Most interventions used printed material, media use or face-to-face training and lasted from 6 weeks to 5 years. Four interventions targeted disadvantaged populations, and three targeted the entire population. In three out of four interventions targeting disadvantaged populations, healthy eating outcomes were improved suggesting they were likely to reduce social inequalities in diet. All interventions directed to the entire population showed improved healthy eating outcomes in all social strata, and were considered as having no impact on social inequalities in diet. In LMICs, agentic interventions promoting healthy eating reduced social inequalities in diet when specifically targeting disadvantaged populations. Further research should assess the impact on social inequalities
Hollands, Gareth J; Marteau, Theresa M
To examine the impact of presenting images of foods paired with images of positive and negative health consequences of their consumption on food choice and attitudes. Participants (N = 711) were randomly allocated in a 2 × 3 factorial design (Food Type × Affective Valence) to 1 of 6 conditioning procedures that paired images of either energy-dense snack foods or fruit, with (a) images of negative health outcomes, (b) images of positive health outcomes, or (c) a no image control. The primary outcome was food choice assessed postintervention with a behavioral choice task. Secondary outcomes were implicit attitudes (assessed pre- and postintervention) and explicit attitudes (assessed postintervention). Presenting images of negative health outcomes led to more healthy food choices relative to control and positive image conditions, irrespective of whether they were paired with images of energy-dense snack foods or fruit. This relationship was partially mediated by changes in implicit and explicit attitudes. Images of positive health outcomes did not alter food choices. This study replicates and extends previous research showing that presenting images of negative health consequences increases healthy food choices. Because effects were elicited by manipulating affective valence irrespective of paired food type, these results appear more consistent with an explanation based on priming than on evaluative conditioning. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Mancino, Lisa; Andrews, Margaret S.
With obesity the most prevalent nutrition problem facing Americans at all economic levels, promoting diets that provide adequate nutrition without too many calories has become an important objective for the Food Stamp Program. Findings from behavioral economics suggest innovative, low-cost ways to improve the diet quality of food stamp participants without restricting their freedom of choice. Unlike more traditional economic interventions, such as changing prices or banning specific foods, th...
Stöckli, Sabrina; Stämpfli, Aline E; Messner, Claude; Brunner, Thomas A
Environmental cues can affect food decisions. There is growing evidence that environmental cues influence how much one consumes. This article demonstrates that environmental cues can similarly impact the healthiness of consumers' food choices. Two field studies examined this effect with consumers of vending machine foods who were exposed to different posters. In field study 1, consumers with a health-evoking nature poster compared to a pleasure-evoking fun fair poster or no poster in their visual sight were more likely to opt for healthy snacks. Consumers were also more likely to buy healthy snacks when primed by an activity poster than when exposed to the fun fair poster. In field study 2, this consumer pattern recurred with a poster of skinny Giacometti sculptures. Overall, the results extend the mainly laboratory-based evidence by demonstrating the health-relevant impact of environmental cues on food decisions in the field. Results are discussed in light of priming literature emphasizing the relevance of preexisting associations, mental concepts and goals. Copyright © 2015 Elsevier Ltd. All rights reserved.
Veling, H.P.; Chen, Z.; Tombrock, M.C.; Verpaalen, I.A.M.; Schmitz, L.I.; Dijksterhuis, A.J.; Holland, R.W.
Many people find it hard to change their dietary choices. Food choice often occurs impulsively, without deliberation, and it has been unclear whether impulsive food choice can be experimentally created. Across 3 exploratory and 2 confirmatory preregistered experiments we examined whether impulsive
McGill, Rory; Anwar, Elspeth; Orton, Lois; Bromley, Helen; Lloyd-Williams, Ffion; O'Flaherty, Martin; Taylor-Robinson, David; Guzman-Castillo, Maria; Gillespie, Duncan; Moreira, Patricia; Allen, Kirk; Hyseni, Lirije; Calder, Nicola; Petticrew, Mark; White, Martin; Whitehead, Margaret; Capewell, Simon
Interventions to promote healthy eating make a potentially powerful contribution to the primary prevention of non communicable diseases. It is not known whether healthy eating interventions are equally effective among all sections of the population, nor whether they narrow or widen the health gap between rich and poor. We undertook a systematic review of interventions to promote healthy eating to identify whether impacts differ by socioeconomic position (SEP). We searched five bibliographic databases using a pre-piloted search strategy. Retrieved articles were screened independently by two reviewers. Healthier diets were defined as the reduced intake of salt, sugar, trans-fats, saturated fat, total fat, or total calories, or increased consumption of fruit, vegetables and wholegrain. Studies were only included if quantitative results were presented by a measure of SEP. Extracted data were categorised with a modified version of the "4Ps" marketing mix, expanded to 6 "Ps": "Price, Place, Product, Prescriptive, Promotion, and Person". Our search identified 31,887 articles. Following screening, 36 studies were included: 18 "Price" interventions, 6 "Place" interventions, 1 "Product" intervention, zero "Prescriptive" interventions, 4 "Promotion" interventions, and 18 "Person" interventions. "Price" interventions were most effective in groups with lower SEP, and may therefore appear likely to reduce inequalities. All interventions that combined taxes and subsidies consistently decreased inequalities. Conversely, interventions categorised as "Person" had a greater impact with increasing SEP, and may therefore appear likely to reduce inequalities. All four dietary counselling interventions appear likely to widen inequalities. We did not find any "Prescriptive" interventions and only one "Product" intervention that presented differential results and had no impact by SEP. More "Place" interventions were identified and none of these interventions were judged as likely to widen
Full Text Available BACKGROUND: Primary prevention of chronic diseases has been suggested to initiate health promotion activities from childhoods. The impact of Isfahan Healthy Heart Program (IHHP, a comprehensive community trial, on unhealthy snacks and fast food intake changes was evaluated in Iranian adolescents between 2001 and 2007. METHODS: Healthy Heart Promotion from Childhood (HHPC as one of the IHHP interventional projects was conducted in adolescents aged 11-18 years, selected randomly by multistage random sampling. Isfahan and Najafabad districts were intervention areas (IA and Arak district was reference area (RA. The baseline and post-intervention surveys were conducted on 1941 and 1997 adolescents, respectively. Healthy lifestyle interventions were performed during the 2nd phase of the study targeting about 410000 students in urban and rural areas of the IA via education, environmental and legislation activities. Dietary intake was assessed annually using a fifty-item food frequency questionnaire in both communities. RESULTS: The interaction of year×area demonstrated that the consumption of unhealthy snacks decreased significantly in middle school boys of RA compared to IA (P for interaction=0.01. However, middle school girls (P for interaction = 0.002 and both sexes of high school students in IA showed a significant reduction in fast food consumption against RA (P for interaction < 0.001. CONCLUSION: The HHPC interventions made some improvement in fast food consumption. It did not show significant decrease regarding unhealthy snacks in adolescents. Proper and higher dose of interventions may be effective in achieving this goal. Keywords: Nutrition, Dietary Behaviour, Adolescent, Lifestyle, Community Trial
Zhou, Xiao; Perez-Cueto, Federico J A; Santos, Quenia Dos; Monteleone, Erminio; Giboreau, Agnès; Appleton, Katherine M; Bjørner, Thomas; Bredie, Wender L P; Hartwell, Heather
Because eating habits are inseparably linked with people's physical health, effective behaviour interventions are highly demanded to promote healthy eating among older people. The aim of this systematic review was to identify effective diet interventions for older people and provide useful evidence and direction for further research. Three electronic bibliographic databases-PubMed, Scopus and Web of Science Core Collection were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria. English language peer-reviewed journal articles published between 2011 and 2016 were selected for data extraction and quality assessment. Finally, a total of 16 studies were identified. The studies' duration ranged from three weeks to seven years. The majority of studies were carried out in European countries. Seven studies had a moderate quality while the remaining studies were at a less than moderate level. Three dietary educational interventions and all meal service related interventions reported improvements in older people's dietary variety, nutrition status, or other health-related eating behaviours. Multicomponent dietary interventions mainly contributed to the reduction of risk of chronic disease. The results supported that older people could achieve a better dietary quality if they make diet-related changes by receiving either dietary education or healthier meal service. Further high-quality studies are required to promote healthy eating among older people by taking regional diet patterns, advanced information technology, and nudging strategies into account.
Lentferink, Aniek Joset; Oldenhuis, Hilbrand; Kulyk, Olga Anatoliyivna; de Groot, Martijn; Polstra, Louis; Velthuijsen, Hugo; Hermens, Hermanus J.; van Gemert-Pijnen, Lisette
The combination of self-tracking and persuasive eCoaching in healthy lifestyle interventions is a promising approach. The objective of this study is to map the key components of existing healthy lifestyle interventions combining self-tracking and persuasive eCoaching using the scoping review
Zhou, Xiao; Perez-Cueto, Armando; dos Santos, Quenia
Because eating habits are inseparably linked with people’s physical health, effective behaviour interventions are highly demanded to promote healthy eating among older people. The aim of this systematic review was to identify effective diet interventions for older people and provide useful evidence...... and direction for further research. Three electronic bibliographic databases—PubMed, Scopus and Web of Science Core Collection were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria. English language peer-reviewed journal articles published between 2011 and 2016 were...... of chronic disease. The results supported that older people could achieve a better dietary quality if they make diet-related changes by receiving either dietary education or healthier meal service. Further high-quality studies are required to promote healthy eating among older people by taking regional diet...
Nørnberg, Trine Riebeling; Houlby, Louise; Skov, Laurits Rohden
towards choice architectural nudge interventions. Methods: Web of Science, Scopus and PubMed were searched systematically for experimental studies with a predefined search strategy in the period November – December 2013. Publications were included following pre-determined inclusion criteria. Studies were...
Casanovas, Ma del Carmen; Lutter, Chessa K; Mangasaryan, Nune; Mwadime, Robert; Hajeebhoy, Nemat; Aguilar, Ana Maria; Kopp, Ciro; Rico, Luis; Ibiett, Gonzalo; Andia, Doris; Onyango, Adelheid W
The risk of stunted growth and development is affected by the context in which a child is born and grows. This includes such interdependent influences as the political economy, health and health care, education, society and culture, agriculture and food systems, water and sanitation, and the environment. Here, we briefly review how factors linked with the key sectors can contribute to healthy growth and reduced childhood stunting. Emphasis is placed on the role of agriculture/food security, especially family farming; education, particularly of girls and women; water, sanitation, and hygiene and their integration in stunting reduction strategies; social protection including cash transfers, bearing in mind that success in this regard is linked to reducing the gap between rich and poor; economic investment in stunting reduction including the work with the for-profit commercial sector balancing risks linked to marketing foods that can displace affordable and more sustainable alternatives; health with emphasis on implementing comprehensive and effective health care interventions and building the capacity of health care providers. We complete the review with examples of national and subnational multi-sectoral interventions that illustrate how critical it is for sectors to work together to reduce stunting. © 2013 John Wiley & Sons Ltd.
Leanne G. Morrison
Full Text Available Choices in the design and delivery of digital health behaviour interventions may have a direct influence on subsequent usage and engagement. Few studies have been able to make direct, detailed comparisons of differences in usage between interventions that are delivered via web or app. This study compared the usage of two versions of a digital stress management intervention, one delivered via a website (Healthy Paths and the other delivered via an app (Healthy Mind. Design modifications were introduced within Healthy Mind to take account of reported differences in how individuals engage with websites compared to apps and mobile phones. Data were collected as part of an observational study nested within a broader exploratory trial of Healthy Mind. Objective usage of Healthy Paths and Healthy Mind were automatically recorded, including frequency and duration of logins, access to specific components within the intervention and order of page/screen visits. Usage was compared for a two week period following initial registration. In total, 381 participants completed the registration process for Healthy Paths (web and 162 participants completed the registration process for Healthy Mind (app. App users logged in twice as often (Mdn = 2.00 as web users (Mdn = 1.00, U = 13,059.50, p ≤ 0.001, but spent half as much time (Mdn = 5.23 min on the intervention compared to web users (Mdn = 10.52 min, U = 19,740.00, p ≤ 0.001. Visual exploration of usage patterns over time revealed that a significantly higher proportion of app users (n = 126, 82.35% accessed both types of support available within the intervention (i.e. awareness and change-focused tools compared to web users (n = 92, 40.17%, χ2(1, n = 382 = 66.60, p < 0.001. This study suggests that the digital platform used to deliver an intervention (i.e. web versus app and specific design choices (e.g. navigation, length and volume of content may be
Brand, Sarah L; Fleming, Lora E; Wyatt, Katrina M
Many healthy workplace interventions have been developed for healthcare settings to address the consistently low scores of healthcare professionals on assessments of mental and physical well-being. Complex healthcare settings present challenges for the scale-up and spread of successful interventions from one setting to another. Despite general agreement regarding the importance of the local setting in affecting intervention success across different settings, there is no consensus on what it is about a local setting that needs to be taken into account to design healthy workplace interventions appropriate for different local settings. Complexity theory principles were used to understand a workplace as a complex adaptive system and to create a framework of eight domains (system characteristics) that affect the emergence of system-level behaviour. This Workplace of Well-being (WoW) framework is responsive and adaptive to local settings and allows a shared understanding of the enablers and barriers to behaviour change by capturing local information for each of the eight domains. We use the results of applying the WoW framework to one workplace, a UK National Health Service ward, to describe the utility of this approach in informing design of setting-appropriate healthy workplace interventions that create workplaces conducive to healthy behaviour change.
Sarah L. Brand
Full Text Available Many healthy workplace interventions have been developed for healthcare settings to address the consistently low scores of healthcare professionals on assessments of mental and physical well-being. Complex healthcare settings present challenges for the scale-up and spread of successful interventions from one setting to another. Despite general agreement regarding the importance of the local setting in affecting intervention success across different settings, there is no consensus on what it is about a local setting that needs to be taken into account to design healthy workplace interventions appropriate for different local settings. Complexity theory principles were used to understand a workplace as a complex adaptive system and to create a framework of eight domains (system characteristics that affect the emergence of system-level behaviour. This Workplace of Well-being (WoW framework is responsive and adaptive to local settings and allows a shared understanding of the enablers and barriers to behaviour change by capturing local information for each of the eight domains. We use the results of applying the WoW framework to one workplace, a UK National Health Service ward, to describe the utility of this approach in informing design of setting-appropriate healthy workplace interventions that create workplaces conducive to healthy behaviour change.
Brand, Sarah L.; Fleming, Lora E.; Wyatt, Katrina M.
Many healthy workplace interventions have been developed for healthcare settings to address the consistently low scores of healthcare professionals on assessments of mental and physical well-being. Complex healthcare settings present challenges for the scale-up and spread of successful interventions from one setting to another. Despite general agreement regarding the importance of the local setting in affecting intervention success across different settings, there is no consensus on what it is about a local setting that needs to be taken into account to design healthy workplace interventions appropriate for different local settings. Complexity theory principles were used to understand a workplace as a complex adaptive system and to create a framework of eight domains (system characteristics) that affect the emergence of system-level behaviour. This Workplace of Well-being (WoW) framework is responsive and adaptive to local settings and allows a shared understanding of the enablers and barriers to behaviour change by capturing local information for each of the eight domains. We use the results of applying the WoW framework to one workplace, a UK National Health Service ward, to describe the utility of this approach in informing design of setting-appropriate healthy workplace interventions that create workplaces conducive to healthy behaviour change. PMID:26380358
Morris, Heather; Skouteris, Helen; Edwards, Susan; Rutherford, Leonie Margaret; Cutter-Mackenzie, Amy; O'Connor, Amanda; Mantilla, Ana; Huang, Terry TK; Lording, Kate Marion; Williams-Smith, Janet
We sought to evaluate the feasibility of conducting a randomized trial to evaluate the efficacy of a preschool/kindergarten curriculum intervention designed to increase 4-year-old children's knowledge of healthy eating, active play and the sustainability consequences of their food and toy choices. Ninety intervention and 65 control parent/child…
Full Text Available Abstract Background The number of overweight children in America has doubled to an estimated 10 million in the past 20 years. Establishing healthy dietary behaviors must begin early in childhood and include parents. The Healthy Toddlers intervention focuses on promoting healthy eating habits in 1- to 3-year-old children utilizing the Social Cognitive Theory and a learner-centered approach using Adult Learning principles. This Healthy Toddlers Trial aims to determine the efficacy of a community-based randomized controlled trial of an in-home intervention with economically and educationally disadvantaged mothers of toddlers. The intervention focuses on: (a promoting healthy eating behaviors in toddlers while dietary habits are forming; and (b providing initial evidence for the potential of Healthy Toddlers as a feasible intervention within existing community-based programs. Methods/Design This describes the study protocol for a randomized control trial, a multi-state project in Colorado, Michigan, and Wisconsin with economically and educationally disadvantaged mother-toddler dyads; toddlers are between 12 and 36 months. The Healthy Toddlers intervention consists of eight in-home lessons and four reinforcement telephone contacts, focusing on fruit, vegetable, and sweetened beverage consumption and parental behaviors, taught by paraprofessional instructors. Healthy Toddlers uses a randomized, experimental, short-term longitudinal design with intervention and control groups. In-home data collection (anthropometric measurements, feeding observations, questionnaires, 3-day dietary records occurs at baseline, immediately following the intervention, and 6 months after the intervention. Main toddler outcomes include: a increased fruit and vegetable consumption and decreased sweetened beverage consumption; and b improved toddler-eating skills (self-feeding and self-serving. Main parent outcomes include: a improved psychosocial attributes (knowledge
Gardner, Jolynn; Kjolhaug, Jerri; Linde, Jennifer A.; Sevcik, Sarah; Lytle, Leslie A.
Purpose: This article describes the effectiveness of goal setting instruction in the CHOICES (Choosing Healthy Options in College Environments and Settings) study, an intervention evaluating the effectiveness of weight gain prevention strategies for 2-year college students. Methods: Four hundred and forty-one participants from three community…
Lara, Jose; Godfrey, Alan; Evans, Elizabeth; Heaven, Ben; Brown, Laura J E; Barron, Evelyn; Rochester, Lynn; Meyer, Thomas D; Mathers, John C
Given the biological complexity of the ageing process, there is no single, simple and reliable measure of how healthily someone is ageing. Intervention studies need a panel of measures which capture key features of healthy ageing. To help guide our research in this area, we have adopted the concept of the "Healthy Ageing Phenotype" (HAP) and this study aimed to (i) identify the most important features of the HAP and (ii) identify/develop tools for measurement of those features. After a comprehensive assessment of the literature we selected the following domains: physiological and metabolic health, physical capability, cognitive function, social wellbeing, and psychological wellbeing which we hoped would provide a reasonably holistic characterisation of the HAP. We reviewed the literature and identified systematic reviews and/or meta-analysis of cohort studies, and clinical guidelines on outcome measures of these domains relevant to the HAP. Selection criteria for these measures included: frequent use in longitudinal studies of ageing; expected to change with age; evidence for strong association with/prediction of ageing-related phenotypes such as morbidity, mortality and lifespan; whenever possible, focus on studies measuring these outcomes in populations rather than on individuals selected on the basis of a particular disease; (bio)markers that respond to (lifestyle-based) intervention. Proposed markers were exposed to critique in a Workshop held in Newcastle, UK in October 2012. We have selected a tentative panel of (bio)markers of physiological and metabolic health, physical capability, cognitive function, social wellbeing, and psychological wellbeing which we propose may be useful in characterising the HAP and which may have utility as outcome measures in intervention studies. In addition, we have identified a number of tools which could be applied in community-based intervention studies designed to enhance healthy ageing. We have proposed, tentatively, a panel
Kamphuis, Carlijn B M; de Bekker-Grob, Esther W; van Lenthe, Frank J
Healthiness, price, and convenience are typically indicated as important motives for food choices; however, it is largely unknown to what extent older adults from high and low socioeconomic groups differ in these underlying motives. A discrete choice experiment (DCE) is an innovative way to elicit implicit motives for food choices. The aim was to investigate differences in food motives between socioeconomic groups by means of a DCE. A DCE was carried out during a face-to-face interview among older adults as part of the Health and Living Conditions in Eindhoven and surrounding cities (GLOBE) cohort study, The Netherlands. Participants (n = 399; mean age: 63.3 y) were offered a series of choice sets about a usual dinner at home and were asked to choose in each choice set between 2 meals and an opt-out choice, with different combinations of attribute levels. We included 5 meal attributes (taste, healthiness, preparation time, travel time to shops, and price) and 3 or 4 levels for each attribute. Data were analyzed by multinomial logit models. Healthiness, taste, price, and travel time to the grocery store proved to significantly influence older adults' meal decisions; preparation time was not significant. Healthiness was the most important attribute for all of the participants. More highly educated participants rated a healthy and less expensive meal to be more important than did less educated participants. Those with a high income rated a meal that was healthy and very tasteful to be more important than did those with a lower income. Healthiness, taste, price, and travel time to grocery shops influenced older adults' meal decisions. Higher socioeconomic groups valued health more than did lower socioeconomic groups. DCEs represent a promising method to gain insight into the relative importance of motives for food choices. This trial was registered at www.isrctn.com as ISRCTN60293770. © 2015 American Society for Nutrition.
Boatemaa, Sandra; Badasu, Delali Margaret; de-Graft Aikins, Ama
Poor communities in low and middle income countries are reported to experience a higher burden of chronic non-communicable diseases (NCDs) and nutrition-related NCDs. Interventions that build on lay perspectives of risk are recommended. The objective of this study was to examine lay understanding of healthy and unhealthy food practices, factors that influence food choices and the implications for developing population health interventions in three urban poor communities in Accra, Ghana. Thirty lay adults were recruited and interviewed in two poor urban communities in Accra. The interviews were audio-taped, transcribed and analysed thematically. The analysis was guided by the socio-ecological model which focuses on the intrapersonal, interpersonal, community, structural and policy levels of social organisation. Food was perceived as an edible natural resource, and healthy in its raw state. A food item retained its natural, healthy properties or became unhealthy depending on how it was prepared (e.g. frying vs boiling) and consumed (e.g. early or late in the day). These food beliefs reflected broader social food norms in the community and incorporated ideas aligned with standard expert dietary guidelines. Healthy cooking was perceived as the ability to select good ingredients, use appropriate cooking methods, and maintain food hygiene. Healthy eating was defined in three ways: 1) eating the right meals; 2) eating the right quantity; and 3) eating at the right time. Factors that influenced food choice included finances, physical and psychological state, significant others and community resources. The findings suggest that beliefs about healthy and unhealthy food practices are rooted in multi-level factors, including individual experience, family dynamics and community factors. The factors influencing food choices are also multilevel. The implications of the findings for the design and content of dietary and health interventions are discussed.
Thorsen, Anne Vibeke; Jørgensen, Michael Søgaard; Mikkelsen, Bent Egberg
The challenge of public health nutrition in relation to worksite settings is to improve access to healthier meal options – especially for the groups with a lower educational level. Strategies changing the dietary environment such as increasing the availability of healthy food and reducing barriers towards healthy eating may help consumers change dietary behavior and meet the guidelines for a healthy diet. The sustainability of interventions is found to be a central challenge in public health ...
Råberg Kjøllesdal, Marte K; Telle Hjellset, Victoria; Bjørge, Benedikte; Holmboe-Ottesen, Gerd; Wandel, Margareta
To explore barriers to healthy dietary changes experienced by Pakistani immigrant women participating in a culturally adapted intervention, and whether these barriers were associated with intentions to change dietary behaviours. Participants were randomly assigned to control and intervention group. The 7-month intervention consisted of six educational group sessions on diet and physical activity, based on knowledge about Pakistani lifestyle and focusing on blood glucose control. Data on barriers for and intentions to healthy dietary changes were collected through an interview with help of a questionnaire. The article is based on data from follow-up assessments in the intervention group, comprising 82 women, aged 28-62 years, without a history of type 2 diabetes. The most important barriers to healthy dietary changes were preferences of children and other family members and perceived expectations during social gatherings. The perceived pressure from other family members was especially strong when the women were trying to change to more vegetables, lentils, and fish and to use less oil in food preparation. The barriers were inversely related to intentions to change. The women encountered various types of barriers when trying to change to healthier food habits, the most prominent being those related to the social dimensions of food consumption, as well as to awareness of the amount of oil used for cooking.
Full Text Available Because eating habits are inseparably linked with people’s physical health, effective behaviour interventions are highly demanded to promote healthy eating among older people. The aim of this systematic review was to identify effective diet interventions for older people and provide useful evidence and direction for further research. Three electronic bibliographic databases—PubMed, Scopus and Web of Science Core Collection were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria. English language peer-reviewed journal articles published between 2011 and 2016 were selected for data extraction and quality assessment. Finally, a total of 16 studies were identified. The studies’ duration ranged from three weeks to seven years. The majority of studies were carried out in European countries. Seven studies had a moderate quality while the remaining studies were at a less than moderate level. Three dietary educational interventions and all meal service related interventions reported improvements in older people’s dietary variety, nutrition status, or other health-related eating behaviours. Multicomponent dietary interventions mainly contributed to the reduction of risk of chronic disease. The results supported that older people could achieve a better dietary quality if they make diet-related changes by receiving either dietary education or healthier meal service. Further high-quality studies are required to promote healthy eating among older people by taking regional diet patterns, advanced information technology, and nudging strategies into account.
Perez-Cueto, Federico J. A.; Santos, Quenia Dos; Monteleone, Erminio; Giboreau, Agnès; Bredie, Wender L. P.; Hartwell, Heather
Because eating habits are inseparably linked with people’s physical health, effective behaviour interventions are highly demanded to promote healthy eating among older people. The aim of this systematic review was to identify effective diet interventions for older people and provide useful evidence and direction for further research. Three electronic bibliographic databases—PubMed, Scopus and Web of Science Core Collection were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria. English language peer-reviewed journal articles published between 2011 and 2016 were selected for data extraction and quality assessment. Finally, a total of 16 studies were identified. The studies’ duration ranged from three weeks to seven years. The majority of studies were carried out in European countries. Seven studies had a moderate quality while the remaining studies were at a less than moderate level. Three dietary educational interventions and all meal service related interventions reported improvements in older people’s dietary variety, nutrition status, or other health-related eating behaviours. Multicomponent dietary interventions mainly contributed to the reduction of risk of chronic disease. The results supported that older people could achieve a better dietary quality if they make diet-related changes by receiving either dietary education or healthier meal service. Further high-quality studies are required to promote healthy eating among older people by taking regional diet patterns, advanced information technology, and nudging strategies into account. PMID:29373529
Nørnberg, Trine; Skov, Laurits Rohden; Houlby, Louise
This study addressed attitudes of using nudging-like measures in community schools to promote healthy food choices among Danish adolescents. Data were successfully collected for 408 respondents. The next step was to prepare descriptive statistics and conduct factor analysis and structural equatio...... it to be acceptable for the school to attempt to intervene with their health-related behavior, but respondents saw it as neither the school's obligation nor responsibility. School-based health promotion could benefit from these findings....
Talaei, Mohammad; Mohammadifard, Noushin; Khaje, Mohammad-Reza; Sarrafzadegan, Nizal; Sajjadi, Firoozeh; Alikhasi, Hasan; Maghroun, Maryam; Iraji, Farhad; Ehteshami, Shahram
The scientific evidences show that the content, baking methods, and types of bread can make health impacts. Bread, as a major part of Iranian diet, demonstrates a significant potential to be targeted as health promotion subject. Healthy Food for Healthy Communities (HFHC) was a project of Isfahan Healthy Heart Program (IHHP), consisting of a wide variety of strategies, like Healthy Bread (HB) Initiative. The HB Initiative was designed to improve the behaviour of both producers and consumers, mainly aiming at making high-fibre, low-salt bread, eliminating the use of baking soda, providing enough rest time for dough before baking (at least one hour), and enough baking time (at least one minute in oven). A workshop was held for volunteer bakers, and a baker-to-baker training protocol under direct supervision was designed for future volunteers. Cereal Organization was persuaded to provide less refined flour that contained more bran. Health messages in support of new breads were disseminated by media and at bakeries by health professionals. Evaluation of the HB Initiative was done using before-after assessments and population surveys. While HB was baked in 1 (0.01%) bakery at baseline, 402 (41%) bakeries in the intervention area joined the HB Initiative in 2009. Soda was completely eliminated and fibre significantly increased from 4 +/- 0.4 g% before study to 12 +/- 0.6 g% after the intervention (p bread decreased from 13 +/- 1.8 g% to 2 +/- 0.5 g% and was expressed as the most important advantage of this initiative by consumers. People who lived in Isfahan city consumed whole bread 6 times more than those who lived in reference area Arak (p breads as a healthy choice that were compatible with local dishes and made a model to solve the longstanding problems of bread. It used various health promotion approaches but was best consistent with Beattie's model.
Broers, Valérie; De Breucker, Céline; Van den Broucke, Stephan; Luminet, Olivier
BACKGROUND: Nudging refers to interventions that organize the choice architecture in order to alter people's behaviour in a predictable way without forbidding any options or significantly changing their economic incentives. As a strategy to encourage healthy behaviour, nudging can serve as a complement to health education. However, the empirical evidence regarding the effectiveness of nudging as a way to influence food choice remains contradictory. To address this issue, a systematic review a...
Ling, Jiying; Robbins, Lorraine B; Zhang, Nanhua; Kerver, Jean M; Lyons, Haley; Wieber, Nicole; Zhang, Mi
The purpose of this pilot quasi-experimental study was to examine the feasibility and preliminary efficacy of using Facebook in a 10-week lifestyle intervention with Head Start caregiver-preschooler dyads to improve healthy behaviors and reduce body mass index. Sixty-nine dyads participated with 39 in the intervention group. Average preschooler attendance rate for the Head Start center-based program was 77%, and caregiver participation rate was 87%. About 94% of the caregivers were satisfied with the program, and 97% would recommend the program to others and/or participate again. The intervention decreased preschoolers' body mass index z score (Cohen's d = -.30) and screen time ( d = -.21), and increased their fruit and vegetable intake ( d = .40) and moderate-to-vigorous physical activity ( d = .42). The intervention increased caregivers' fruit and vegetable intake ( d = .40). The intervention is feasible, and preliminary efficacy is encouraging, but further investigation using a rigorous study design is warranted.
Kraak, V I; Englund, T; Misyak, S; Serrano, E L
This review identified and adapted choice architecture frameworks to develop a novel framework that restaurant owners could use to promote healthy food environments for customers who currently overconsume products high in fat, sugar and sodium that increase their risk of obesity and diet-related non-communicable diseases. This review was conducted in three steps and presented as a narrative summary to demonstrate a proof of concept. Step 1 was a systematic review of nudge or choice architecture frameworks used to categorize strategies that cue healthy behaviours in microenvironments. We searched nine electronic databases between January 2000 and December 2016 and identified 1,244 records. Inclusion criteria led to the selection of five choice architecture frameworks, of which three were adapted and combined with marketing mix principles to highlight eight strategies (i.e. place, profile, portion, pricing, promotion, healthy default picks, prompting or priming and proximity). Step 2 involved conducting a comprehensive evidence review between January 2006 and December 2016 to identify U.S. recommendations for the restaurant sector organized by strategy. Step 3 entailed developing 12 performance metrics for the eight strategies. This framework should be tested to determine its value to assist restaurant owners to promote and socially normalize healthy food environments to reduce obesity and non-communicable diseases. © 2017 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.
... Thalassemia” More What can a person living with thalassemia do to stay healthy? A healthy lifestyle is ... disorder”, as well as making healthy choices. Managing Thalassemia Thalassemia is a treatable disorder that can be ...
Kato-Lin, Yi-Chin; Padman, Rema; Downs, Julie; Abhishek, Vibhanshu
Mobile apps have great potential to deliver promising interventions to engage consumers and change their health-related behaviors, such as healthy eating. Currently, the interventions for promoting healthy eating are either too onerous to keep consumers engaged or too restrictive to keep consumers connected with healthcare professionals. In addition, while social media allows individuals to receive information from many sources, it is unclear how peer support interacts with professional support in the context of such interventions. This study proposes and evaluates three mobile-enabled interventions to address these challenges. We examine their effects on user engagement and food choices via a 4-month randomized field experiment. Mixed models provide strong evidence of the positive effect of image-based dietitian support and negative effects of peer support, and moderate evidence of the positive effects of mobile-based visual diary, highlighting the value of mobile apps for delivering advanced interventions to engage users and facilitate behavior change.
Full Text Available Background: Low-carbohydrate (LC diets have gained substantial media coverage in many Western countries. Little is, however, known about the characteristics of their followers. Objective: The article analyses how those who report following an LC diet differ from the rest of the population in their background, food choices, weight reduction status, as well as food-related perceptions and motives. The data are a part of the Health Behaviour and Health among the Finnish Adult Population survey collected in spring 2012 (n=2,601, covering 15- to 64-year-old Finns. Results: Seven per cent of the respondents identified themselves as followers of the LC diet. Gender and education were not associated with following an LC diet. The youngest respondents were the least likely to follow such a diet. The LC diet group preferred butter but also vegetables more commonly than the other respondents and were less likely to use vegetable bread spreads. The followers of the LC diet and the other respondents agreed about the healthiness of whole grain, vegetable oils, vegetables, and fruits and berries, and of the harmfulness of white wheat. Compared to the other respondents, the LC diet group was less likely to regard eating vegetable/low-fat products as important, more likely to regard eating healthy carbohydrates, and the health and weight-managing aspects of foods, as important and placed less value on sociability and pleasures connected to food. The results showed varying food choices among the followers of the LC diet: some even reported that they were not avoiding carbohydrates, sugars, and white wheat in their diet. Conclusions: Planners of nutrition policies should follow-up on new diets as they emerge and explore the food choices and motives of their followers and how these diets affect the food choices of the whole population.
Jallinoja, Piia; Niva, Mari; Helakorpi, Satu; Kahma, Nina
Low-carbohydrate (LC) diets have gained substantial media coverage in many Western countries. Little is, however, known about the characteristics of their followers. The article analyses how those who report following an LC diet differ from the rest of the population in their background, food choices, weight reduction status, as well as food-related perceptions and motives. The data are a part of the Health Behaviour and Health among the Finnish Adult Population survey collected in spring 2012 (n=2,601), covering 15- to 64-year-old Finns. Seven per cent of the respondents identified themselves as followers of the LC diet. Gender and education were not associated with following an LC diet. The youngest respondents were the least likely to follow such a diet. The LC diet group preferred butter but also vegetables more commonly than the other respondents and were less likely to use vegetable bread spreads. The followers of the LC diet and the other respondents agreed about the healthiness of whole grain, vegetable oils, vegetables, and fruits and berries, and of the harmfulness of white wheat. Compared to the other respondents, the LC diet group was less likely to regard eating vegetable/low-fat products as important, more likely to regard eating healthy carbohydrates, and the health and weight-managing aspects of foods, as important and placed less value on sociability and pleasures connected to food. The results showed varying food choices among the followers of the LC diet: some even reported that they were not avoiding carbohydrates, sugars, and white wheat in their diet. Planners of nutrition policies should follow-up on new diets as they emerge and explore the food choices and motives of their followers and how these diets affect the food choices of the whole population.
Williams, Amanda; Wiggers, John; OʼBrien, Kate M; Wolfenden, Luke; Yoong, Sze Lin; Hodder, Rebecca K; Lee, Hopin; Robson, Emma K; McAuley, James H; Haskins, Robin; Kamper, Steven J; Rissel, Chris; Williams, Christopher M
We assessed the effectiveness of a 6-month healthy lifestyle intervention, on pain intensity in patients with chronic low back pain who were overweight or obese. We conducted a pragmatic randomised controlled trial, embedded within a cohort multiple randomised controlled trial of patients on a waiting list for outpatient orthopaedic consultation at a tertiary hospital in NSW, Australia. Eligible patients with chronic low back pain (>3 months in duration) and body mass index ≥27 kg/m and education and referral to a 6-month telephone-based healthy lifestyle coaching service, or usual care. The primary outcome was pain intensity measured using an 11-point numerical rating scale, at baseline, 2 weeks, and monthly for 6 months. Data analysis was by intention-to-treat according to a prepublished analysis plan. Between May 13, 2015, and October 27, 2015, 160 patients were randomly assigned in a 1:1 ratio to the intervention or usual care. We found no difference between groups for pain intensity over 6 months (area under the curve, mean difference = 6.5, 95% confidence interval -8.0 to 21.0; P = 0.38) or any secondary outcome. In the intervention group, 41% (n = 32) of participants reported an adverse event compared with 56% (n = 45) in the control group. Our findings show that providing education and advice and telephone-based healthy lifestyle coaching did not benefit patients with low back pain who were overweight or obese, compared with usual care. The intervention did not influence the targeted healthy lifestyle behaviours proposed to improve pain in this patient group.
Alblas, Eva; Folkvord, Frans; Anschütz, Doeschka J; van 't Riet, Jonathan; Granic, Isabela; Ketelaar, Paul; Buijzen, Moniek
Improving diets by stimulating fruit and vegetable consumption might be beneficial, in particular when they substitute energy-dense products. The aim of present study was to investigate whether a health game can be used to positively affect healthy implicit attitudes (IAs) towards food and subsequent food choice behaviour of young adults. A 2 (Time: baseline vs. post-test) x 2 (Condition: health game vs. control game) x 2 (Baseline IAs: healthy IAs vs. less healthy IAs) mixed-subjects design was used with 125 participants (age: M = 20.17, SD = 1.88). IAs towards food were assessed at baseline and post-test using an Implicit Association Test (IAT). Additionally, food choice behaviour was assessed after game play. At baseline, the majority of participants had healthy IAs (i.e., favouring fruit over chocolate snacks). At post-test, significantly less healthy IAs were observed in the control condition, while this reduction was not significant in the health game condition. Regarding food choice behaviour, participants with healthy baseline IAs were more likely to select fruit in the health game condition than participants with healthy baseline IAs in the control game condition. However, participants with less healthy baseline IAs were less likely to select fruit in the health game condition than in the control condition. We found tentative support that health games can be used to influence IAs towards food and positively affect food choice behaviour. However, this influence was only observed for those with healthy baseline IAs. The current version of the health game would primarily benefit those already healthy and could negatively affect those that need the intervention most, so modifications are recommendable. Copyright © 2018. Published by Elsevier Ltd.
Greaney, Mary L.; Puleo, Elaine; Bennett, Gary G.; Haines, Jess; Viswanath, K.; Gillman, Matthew W.; Sprunck-Harrild, Kim; Coeling, Molly; Rusinak, Donna; Emmons, Karen M.
Background: Many U.S. adults have multiple behavioral risk factors, and effective, scalable interventions are needed to promote population-level health. In the health care setting, interventions are often provided in print, although accessible to nearly everyone, are brief (e.g., pamphlets), are not interactive, and can require some logistics…
Song, Hee-Jung; Gittelsohn, Joel; Kim, Miyong; Suratkar, Sonali; Sharma, Sangita; Anliker, Jean
While corner store-based nutrition interventions have emerged as a potential strategy to increase healthy food availability in low-income communities, few evaluation studies exist. We present the results of a trial in Baltimore City to increase the availability and sales of healthier food options in local stores. Quasi-experimental study. Corner stores owned by Korean-Americans and supermarkets located in East and West Baltimore. Seven corner stores and two supermarkets in East Baltimore received a 10-month intervention and six corner stores and two supermarkets in West Baltimore served as comparison. During and post-intervention, stocking of healthy foods and weekly reported sales of some promoted foods increased significantly in intervention stores compared with comparison stores. Also, intervention storeowners showed significantly higher self-efficacy for stocking some healthy foods in comparison to West Baltimore storeowners. Findings of the study demonstrated that increases in the stocking and promotion of healthy foods can result in increased sales. Working in small corner stores may be a feasible means of improving the availability of healthy foods and their sales in a low-income urban community.
Waqa, Gade; Moodie, Marj; Schultz, Jimaima; Swinburn, Boyd
Nearly one-half of the adult population in Fiji between the ages of 15-64 years is either overweight or obese; and rates amongst school children have, on average, doubled during the last decade. There is an urgent need to scale up the promotion of healthy behaviors and environments using a multi-sectoral approach. The Healthy Youth Healthy Community (HYHC) project in Fiji used a settings approach in secondary schools and faith-based organizations to increase the capacity of the whole community, including churches, mosques and temples, to promote healthy eating and regular physical activity, and to prevent unhealthy weight gain in adolescents aged 13-18 years. The team consisted of a study manager, project coordinator and four research assistants (RAs) committed to planning, designing and facilitating the implementation of intervention programs in collaboration with other stakeholders, such as the wider school communities, government and non-governmental organizations and business partners. Process data were collected on all intervention activities and analyzed by dose, frequency and reach for each specific strategy. The Fiji Action Plan included nine objectives for the school settings; four were based on nutrition and two on physical activity in schools, plus three general objectives, namely capacity building, social marketing and evaluation. Long-term change in nutritional behavior was difficult to achieve; a key contributor to this was the unhealthy food served in the school canteens. Whilst capacity-building proved to be one of the best mechanisms for intervening, it is important to consider the cultural and social factors influencing health behaviors and affecting specific groups.
Pathirana, Thanya; Stoneman, Rebecca; Lamont, Amanda; Harris, Neil; Lee, Patricia
Childhood obesity is rising in prevalence in Australia. This study aimed to evaluate the impact of the "Have Fun-Be Healthy" (HFBH) intervention, delivered in the Playgroup setting, to generate short term changes in dietary, physical activity and sedentary behaviours of children under 5 years and self-efficacy of parents and primary carers. This intervention consisted of eight structured cooking and physical play sessions delivered over a period of 8 weeks by trained facilitators. Pre- and post-intervention data collection was performed using survey questionnaires administered to parents and carers of children under 5 years from low socioeconomic backgrounds recruited through convenience sampling. A total of 640 pre-intervention surveys and 312 post-intervention surveys were returned. The matched response rate was 45.5%. There was an improvement in mean intake of healthy foods and mean physical activity with a decrease in mean intake of unhealthy food and mean screen time in children (P > .05). Following the intervention, parental/carer self-efficacy in promoting healthy eating and limiting screen time of children improved significantly (P < .05). Children's physical activity levels and consumption of healthy foods were positively correlated with parental/carer self-efficacy (P < .01) while screen time and consumption of unhealthy foods were negatively correlated (P < .01). HFBH intervention was successful in improving the dietary, physical activity and screen time in children and parental self-efficacy. SO WHAT?: Being amongst the first of its' kind in Australia, the findings of this study can have implications for developing and implementing similar future health promotion interventions in comparable settings. © 2017 Australian Health Promotion Association.
as a motivating factor. Situational factors dominated consumers' food choice considerations, often in patterns developing coherence over time. It is concluded that consumers hold elaborate health belief systems, but that a lack of situational accessibility generally prevents them from gaining influence on actual......Consumer research on healthy food choices often suffers from context effects and low predictive validity. Adopting a social cognition perspective, the paper proposes that consumers hold elaborate belief systems about food and health issues, but that these are only selectively accessed in different...... situations. Three studies are reported. In Study 1, 525 consumers answered a belief questionnaire. Structural equation modelling results demonstrate that health beliefs, when made accessible, form an interconnected system that can motivate successful self-regulation of healthy eating behaviour. Through...
Pot, Gerda K; Richards, Marcus; Prynne, Celia J; Stephen, Alison M
Current indices of diet quality generally include intakes of specific foods or nutrients. We sought to develop an index that discriminates healthy and unhealthy eating choices for use in large surveys as a short questionnaire and as a measure in existing studies with adequate dietary data. The Eating Choices Index (ECI) score included four components: (i) consumption of breakfast, (ii) consumption of two portions of fruit per day, (iii) type of milk consumed and (iv) type of bread consumed, each providing a score from 1 to 5. In analysis of 5 d food records, the ECI score was examined in relation to macronutrients, fibre, vitamin C, Fe, Ca and folate using Pearson correlations. Variation with sex, BMI, socio-economic status, marital status, smoking status and physical activity were also investigated. Medical Research Council National Survey of Health and Development. Individuals (n 2256) aged 43 years. The ECI score (mean 12·3 (sd 3·5)) was significantly positively associated with protein, carbohydrate, fibre, vitamin C, Fe, Ca and folate (r = 0·2-0·5; P < 0·001) and significantly negatively associated with fat intake (r = -0·2; P < 0·001); ECI scores were not correlated with total energy intake. Individuals with a lower ECI score were more likely to be men (P < 0·001), overweight or obese (P < 0·001), have lower socio-economic status (P < 0·001), smoke more (P < 0·001) and be less physically active (P < 0·001). ECI scores correlated with nutrient profiles consistent with a healthy diet. It provides a simple method to rank diet healthiness in large observational studies.
Ball, Stephen; Kovarik, Jessica; Leidy, Heather
The Active and Healthy School Program (AHS) can be used to alter the culture and environment of a school to help children make healthier choices. The purpose of this study was to determine the effectiveness of AHS to increase physical activity while decreasing total screen time, increase healthy food choices, and improve knowledge about physical…
Full Text Available Abstract BACKGROUND: Although the relationship between unhealthy lifestyle and development of non-communicable diseases in the youth has been understood but intervention studies to improve lifestyle behaviors in this age group are low. Consequently, this study was performed to highlight important intervention activity of a NCD prevention and health promotion program for young people and to present its main results in Iran. METHODS: The Youth Intervention Project (YIP as a part of Isfahan Healthy Heart Program (IHHP was carried out on all the youth aged 19-25 years in Isfahan and Najafabad counties as intervention areas and Arak as control area. The target groups could be reached in Red Crescent Society, universities, and garrisons. Multifactorial interventions included healthy nutrition, physical activity, coping with stress, and tobacco cessation by more emphasis on hookah smoking. Also, enforcing no-smoking regulations in teahouses and coffee shops was considered. RESULTS: After performing multifactorial interventions, the change of fast food consumption frequency was statistically significant in comparison between intervention and control areas (P for trend<0.05. Percentage of individuals with high stress level were more significant in intervention area compared with control area (P for trend<0.05. Smoking was increased among men and women in both areas whereas the increase was higher in control area (P for trend<0.05. Although daily physical activity frequency was increased in intervention areas but it wasn’t significant compared with control area. Also, decreased trend of carbonated drink consumption were not significant in intervention area compared with control area. CONCLUSION: The lifestyle modification program in the youth was successfully implemented and was shown to have improved some of the youth’s lifestyle behaviors related to healthy lifestyle. Keywords: Intervention,The youth, Non
Miller, Jane; Lee, Amanda; Obersky, Natalie; Edwards, Rachael
The present paper reports on a quality improvement activity examining implementation of A Better Choice Healthy Food and Drink Supply Strategy for Queensland Health Facilities (A Better Choice). A Better Choice is a policy to increase supply and promotion of healthy foods and drinks and decrease supply and promotion of energy-dense, nutrient-poor choices in all food supply areas including food outlets, staff dining rooms, vending machines, tea trolleys, coffee carts, leased premises, catering, fundraising, promotion and advertising. An online survey targeted 278 facility managers to collect self-reported quantitative and qualitative data. Telephone interviews were sought concurrently with the twenty-five A Better Choice district contact officers to gather qualitative information. Public sector-owned and -operated health facilities in Queensland, Australia. One hundred and thirty-four facility managers and twenty-four district contact officers participated with response rates of 48.2% and 96.0%, respectively. Of facility managers, 78.4% reported implementation of more than half of the A Better Choice requirements including 24.6% who reported full strategy implementation. Reported implementation was highest in food outlets, staff dining rooms, tea trolleys, coffee carts, internal catering and drink vending machines. Reported implementation was more problematic in snack vending machines, external catering, leased premises and fundraising. Despite methodological challenges, the study suggests that policy approaches to improve the food and drink supply can be implemented successfully in public-sector health facilities, although results can be limited in some areas. A Better Choice may provide a model for improving food supply in other health and workplace settings.
Dundas, Ingrid; Binder, Per Einar; Hansen, Tia G.B.
negative self-directed thinking; as well as for self-compassion, anxiety and depression. Concluding, a short self-compassion course seems an effective method of increasing self-compassion and perceived control over one's life for university students, as well as increasing mental health.......The primary aim of this study was to examine the effects of a two-week self-compassion course on healthy self-regulation (personal growth self-efficacy and healthy impulse control) and unhealthy self-regulation (self-judgment and habitual negative self-directed thinking) in university students. We...... also examined the effects on self-compassion, anxiety and depression. Students (N = 158, 85% women, mean age = 25 years) were randomized to an intervention group and a waiting-list control group in a multi-baseline randomized control trial. Healthy self-control was measured by the Personal Growth...
Full Text Available In the last decades, nutrition labels have provided an increasing amount of information about the nutritional value of a foodstuff, in a variety of patterns, having the main goal to help consumers in making healthier food choices. Now, many questions appeared related to the effectiveness of nutrition information in guiding the consumer purchasing behaviour, by encouraging the healthy foods choice. It becomes increasingly clear that many consumers have difficulties in understanding the nutritional information, preferring a simpler way in providing this information, helping them in the rapid evaluation of the nutritional characteristics of a foodstuff. In response to the obvious need to develop a more effective presentation of nutritional information, which convey this information in a simplified and systematic manner, manufacturers and retailers from different countries have created some systems for signalling the nutritional profile. For the nutritional information of greatest interest to be easily perceived by consumers, they have used various forms of graphical representation, that were marked on the front of individual packages (generically called "front of package" - FOP. Although created in order to facilitate healthy food choices, the effect of these FOP systems on consumers is now controversial. Following a literature review, the paper highlights the main benefits and limitations of the widely used FOP systems in the European Union ("Traffic Light" and "Guideline Daily Amounts". The paper presents also some suggestions for developing an optimal FOP system, standardized and adapted to consumers` needs.
Simonsen, Sara E; Digre, Kathleen B; Ralls, Brenda; Mukundente, Valentine; Davis, France A; Rickard, Sylvia; Tavake-Pasi, Fahina; Napia, Eru Ed; Aiono, Heather; Chirpich, Meghan; Stark, Louisa A; Sunada, Grant; Keen, Kassy; Johnston, Leanne; Frost, Caren J; Varner, Michael W; Alder, Stephen C
Utah women from some cultural minority groups have higher overweight/obesity rates than the overall population. We utilized a gender-based mixed methods approach to learn about the underlying social, cultural and gender issues that contribute to the increased obesity risk among these women and to inform intervention development. A literature review and analysis of Utah's Behavioral Risk Factor Surveillance System data informed the development of a focus group guide. Focus groups were conducted with five groups of women: African immigrants from Burundi and Rwanda, African Americans, American Indians/Alaskan Natives, Hispanics/Latinas, and Pacific Islanders. Six common themes emerged: (1) health is multidimensional and interventions must address health in this manner; (2) limited resources and time influence health behaviors; (3) norms about healthy weight vary, with certain communities showing more preference to heavier women; (4) women and men have important but different influences on healthy lifestyle practices within households; (5) women have an influential role on the health of families; and (6) opportunities exist within each group to improve health. Seeking insights from these five groups of women helped to identify common and distinct cultural and gender themes related to obesity, which can be used to help elucidate core obesity determinants. Copyright © 2014 Elsevier Ltd. All rights reserved.
Antoñanzas, Fernando; Rodríguez-Ibeas, Roberto
In this paper, we carry out a theoretical analysis of the strategic choice made by firms regarding the type of food they market when they face consumers who care about the healthy/unhealthy attributes of the product but incur in emotional/health costs when the food they consume has unhealthy attributes. We consider a two-stage game. In the first stage, one of the firms chooses the unhealthy content of its product. In the second stage, both firms simultaneously decide their prices. We find that, depending on the parameters of the model, product differentiation can be maximal or less than maximal. The firm that produces the unhealthy food charges a higher price and obtains a larger share of the market unless the emotional/health costs and the unhealthy food production costs are relatively high. We also find that educational campaigns will not always reduce the demand for the unhealthy food or the degree of the unhealthy attribute.JEL Classification:I10, I18, L11.
van Gestel, L.C.; Kroese, F.M.; de Ridder, D.T.D.
Objective The current study is a longitudinal conceptual replication and aimed to investigate the effect of a food repositioning nudge on healthy food choice in a kiosk. Design During eight weeks, sales data were collected. The former four weeks formed the baseline phase and the latter four weeks
Müller, Andre Matthias; Alley, Stephanie; Schoeppe, Stephanie; Vandelanotte, Corneel
Promoting physical activity and healthy eating is important to combat the unprecedented rise in NCDs in many developing countries. Using modern information-and communication technologies to deliver physical activity and diet interventions is particularly promising considering the increased proliferation of such technologies in many developing countries. The objective of this systematic review is to investigate the effectiveness of e-& mHealth interventions to promote physical activity and healthy diets in developing countries. Major databases and grey literature sources were searched to retrieve studies that quantitatively examined the effectiveness of e-& mHealth interventions on physical activity and diet outcomes in developing countries. Additional studies were retrieved through citation alerts and scientific social media allowing study inclusion until August 2016. The CONSORT checklist was used to assess the risk of bias of the included studies. A total of 15 studies conducted in 13 developing countries in Europe, Africa, Latin-and South America and Asia were included in the review. The majority of studies enrolled adults who were healthy or at risk of diabetes or hypertension. The average intervention length was 6.4 months, and text messages and the Internet were the most frequently used intervention delivery channels. Risk of bias across the studies was moderate (55.7 % of the criteria fulfilled). Eleven studies reported significant positive effects of an e-& mHealth intervention on physical activity and/or diet behaviour. Respectively, 50 % and 70 % of the interventions were effective in promoting physical activity and healthy diets. The majority of studies demonstrated that e-& mHealth interventions were effective in promoting physical activity and healthy diets in developing countries. Future interventions should use more rigorous study designs, investigate the cost-effectiveness and reach of interventions, and focus on emerging technologies, such as
Arena, Ross; Lavie, Carl J; Hivert, Marie-France; Williams, Mark A; Briggs, Paige D; Guazzi, Marco
Unhealthy lifestyle characteristics (i.e., physical inactivity, excess body mass, poor diet, and smoking) as well as associated poor health metrics (i.e., dyslipidemia, hyperglycemia, and hypertension) are the primary reasons for the current non-communicable disease crisis. Compared to those with the poorest of lifestyles and associated health metrics, any movement toward improving lifestyle and associated health metrics improves health outcomes. To address the non-communicable disease crisis we must: 1) acknowledge that healthy lifestyle (HL) interventions are a potent medicine; and 2) move toward a healthcare system that embraces primordial as much as, if not more than, secondary prevention with a heavy focus on HL medicine. This article introduces the Healthy Lifestyle Practitioner, focused on training health professionals to deliver HL medicine.
Beccarelli, Lori M; Scherr, Rachel E; Dharmar, Madan; Ermakov, Igor V; Gellermann, Werner; Jahns, Lisa; Linnell, Jessica D; Keen, Carl L; Steinberg, Francene M; Young, Heather M; Zidenberg-Cherr, Sheri
To determine whether fourth-grade students participating in the Shaping Healthy Choices Program (SHCP), a school-based nutrition intervention, would change vegetable and carotenoid intake measured by skin carotenoids and dietary intake. Single-group pretest-posttest with a self-selected, convenience sample of students (n = 30) participating in the SHCP, which lasted 1 academic year (9 months). Dietary intake of vegetables and carotenoids as measured by Block food frequency questionnaire and skin carotenoids as measured by Raman spectroscopy were collected at the school preintervention and postintervention. Reported carotenoid intake decreased by 1.5 mg (P = .05) and skin carotenoids decreased by 2,247.9 RRS intensity units (P = .04). Change in reported intake correlated with change in skin carotenoids (r = .43; P = .02). The reported decrease in vegetable and carotenoid intake was unanticipated; nevertheless, the RRS measurements confirmed this. RRS data can help evaluate changes in fruit and vegetable intake. Copyright © 2016 Society for Nutrition Education and Behavior. All rights reserved.
Talaei, Mohammad; Khaje, Mohammad-Reza; Sarrafzadegan, Nizal; Sajjadi, Firoozeh; Alikhasi, Hasan; Maghroun, Maryam; Iraji, Farhad; Ehteshami, Shahram
The scientific evidences show that the content, baking methods, and types of bread can make health impacts. Bread, as a major part of Iranian diet, demonstrates a significant potential to be targeted as health promotion subject. Healthy Food for Healthy Communities (HFHC) was a project of Isfahan Healthy Heart Program (IHHP), consisting of a wide variety of strategies, like Healthy Bread (HB) Initiative. The HB Initiative was designed to improve the behaviour of both producers and consumers, mainly aiming at making high-fibre, low-salt bread, eliminating the use of baking soda, providing enough rest time for dough before baking (at least one hour), and enough baking time (at least one minute in oven). A workshop was held for volunteer bakers, and a baker-to-baker training protocol under direct supervision was designed for future volunteers. Cereal Organization was persuaded to provide less refined flour that contained more bran. Health messages in support of new breads were disseminated by media and at bakeries by health professionals. Evaluation of the HB Initiative was done using before-after assessments and population surveys. While HB was baked in 1 (0.01%) bakery at baseline, 402 (41%) bakeries in the intervention area joined the HB Initiative in 2009. Soda was completely eliminated and fibre significantly increased from 4±0.4 g% before study to 12±0.6 g% after the intervention (p<0.001). The preparation and baking times remarkably increased. Wastage of bread decreased from 13±1.8 g% to 2±0.5 g% and was expressed as the most important advantage of this initiative by consumers. People who lived in Isfahan city consumed whole bread 6 times more than those who lived in reference area Arak (p<0.001). The HB Initiative managed to add new breads as a healthy choice that were compatible with local dishes and made a model to solve the long-standing problems of bread. It used various health promotion approaches but was best consistent with Beattie's model. PMID
Tomayko, Emily J; Prince, Ronald J; Cronin, Kate A; Parker, Tassy; Kim, Kyungmann; Grant, Vernon M; Sheche, Judith N; Adams, Alexandra K
Background/Aims Few obesity prevention trials have focused on young children and their families in the home environment, particularly in underserved communities. Healthy Children, Strong Families 2 is a randomized controlled trial of a healthy lifestyle intervention for American Indian children and their families, a group at very high risk of obesity. The study design resulted from our long-standing engagement with American Indian communities, and few collaborations of this type resulting in the development and implementation of a randomized clinical trial have been described. Methods Healthy Children, Strong Families 2 is a lifestyle intervention targeting increased fruit and vegetable intake, decreased sugar intake, increased physical activity, decreased TV/screen time, and two less-studied risk factors: stress and sleep. Families with young children from five American Indian communities nationwide were randomly assigned to a healthy lifestyle intervention ( Wellness Journey) augmented with social support (Facebook and text messaging) or a child safety control group ( Safety Journey) for 1 year. After Year 1, families in the Safety Journey receive the Wellness Journey, and families in the Wellness Journey start the Safety Journey with continued wellness-focused social support based on communities' request that all families receive the intervention. Primary (adult body mass index and child body mass index z-score) and secondary (health behaviors) outcomes are assessed after Year 1 with additional analyses planned after Year 2. Results To date, 450 adult/child dyads have been enrolled (100% target enrollment). Statistical analyses await trial completion in 2017. Lessons learned Conducting a community-partnered randomized controlled trial requires significant formative work, relationship building, and ongoing flexibility. At the communities' request, the study involved minimal exclusion criteria, focused on wellness rather than obesity, and included an active
El Koussa, Maria; Atun, Rifat; Bowser, Diana; Kruk, Margaret E
The movement of skilled physicians from the public to the private sector is a key constraint to achieving universal health coverage and is currently affecting health systems worldwide. This systematic review aims to assess factors influencing physicians' choice of workplace, and policy interventions for retaining physicians in the public sector. Five literature databases were searched. Studies were included in the review if they focused on at least one of the following criteria: (i) incentives or motivators for retaining physicians in the public sector, (ii) pull factors that encouraged physicians to move to the private sector, (iii) push factors that forced physicians to leave the public sector, (iv) policy interventions or case studies that addressed physician retention in the public sector, and (v) qualitative reviews of policy interventions that were implemented in different health system settings. Nineteen articles met the inclusion criteria. Six major themes that affected physicians' choice of workplace were identified including: financial incentives, career development, infrastructure and staffing, professional work environment, workload and autonomy. The majority of the studies suggested that the use of financial incentives was a motivator in retaining physicians in the public sector. The review also identified policy interventions including: regulatory controls, incentives and management reforms. Regulatory controls and incentives were the two most frequently reported policy interventions. While factors affecting physicians' choice of workplace are country specific, financial incentives and professional development are core factors. Other factors are highly influenced by context, and thus, it would be useful for future cross-country research to use standardized data collection tools, allowing comparison of contextual factors as well as the examination of how context affects physician retention in the public sector.
Marty, Lucile; Chambaron, Stéphanie; Nicklaus, Sophie; Monnery-Patris, Sandrine
Across the lifespan, eating is a common everyday act driven by the search for pleasure and reinforced by experienced pleasure. Pleasure is an innate indicator of the satisfaction of physiological needs, in addition to other attributes. Pleasure from eating is also learned and contributes to the development of children's eating habits, which remain mostly stable until adulthood. Based on classical models of determinants of food consumption behaviour, we identified three dimensions of pleasure from eating learned during childhood: 1/the sensory dimension, i.e., pleasure from sensory sensations during food consumption; 2/the interpersonal dimension, i.e., pleasure from the social context of food consumption; and 3/the psychosocial dimension, i.e., pleasure from cognitive representations of food. The objective of this narrative review is to explore whether these three dimensions may play a role in promotion of healthy eating behaviour among children. Up to now, it was assumed that providing nutritional information, pointing out which types of foods are "good" or "bad" for health, would drive healthier food choices in children. Today, we know that such strategies based on a cognitive approach toward eating have a limited impact on healthy choices and can even be counter-productive, leading children to avoid healthy foods. In the context of increasing rates of childhood obesity, new perspectives are needed to build efficient interventions that might help children adopt a healthy diet. This review suggests new directions for further research to test the efficacy of novel interventions that emphasize pleasure from eating. Copyright © 2017 Elsevier Ltd. All rights reserved.
Thayer, Linden M.; Pimentel, Daniela C.; Smith, Janice C.; Garcia, Beverly A.; Lee Sylvester, Laura; Kelly, Tammy; Johnston, Larry F.; Ammerman, Alice S.; Keyserling, Thomas C.
Background As Americans commonly consume restaurant foods with poor dietary quality, effective interventions are needed to improve food choices at restaurants. Purpose To design and evaluate a restaurant-based intervention to help customers select and restaurants promote heart healthy menu items with healthful fats and high quality carbohydrates. Methods The intervention included table tents outlining 10 heart healthy eating tips, coupons promoting healthy menu items, an information brochure, and link to study website. Pre and post intervention surveys were completed by restaurant managers and customers completed a brief “intercept” survey. Results Managers (n = 10) reported the table tents and coupons were well received, and several noted improved personal nutrition knowledge. Overall, 4214 coupons were distributed with 1244 (30%) redeemed. Of 300 customers surveyed, 126 (42%) noticed the table tents and of these, 115 (91%) considered the nutrition information helpful, 42 (33%) indicated the information influenced menu items purchased, and 91 (72%) reported the information will influence what they order in the future. Discussion The intervention was well-received by restaurant managers and positively influenced menu item selection by many customers. Translation to Health Education Practice Further research is needed to assess effective strategies for scaling up and sustaining this intervention approach. PMID:28947925
Dodson, Jennifer L; Hsiao, Ya-Chun; Kasat-Shors, Madhuri; Murray, Laura; Nguyen, Nga Kim; Richards, Adam K; Gittelsohn, Joel
To understand influences on diet among low-income African-American adolescents in East Baltimore. Formative research was conducted for a food store-centered healthy diet intervention targeted to inner-city youth. Family, school and neighborhood influences on eating habits and health concepts were explored. Family structure, economic resources and past experiences influence what food means to adolescents. Healthy food in school and local stores is limited. Terminology to categorize foods was identified, including the term "home foods". Suggested adolescent nutritional interventions include promotion of home-based eating, improving availability of healthy foods in school and neighborhood stores, and targeted educational materials.
Berkman, Elliot T
Traditional models of health behaviour focus on the roles of cognitive, personality and social-cognitive constructs (e.g. executive function, grit, self-efficacy), and give less attention to the process by which these constructs interact in the moment that a health-relevant choice is made. Health psychology needs a process-focused account of how various factors are integrated to produce the decisions that determine health behaviour. I present an integrative value-based choice model of health behaviour, which characterises the mechanism by which a variety of factors come together to determine behaviour. This model imports knowledge from research on behavioural economics and neuroscience about how choices are made to the study of health behaviour, and uses that knowledge to generate novel predictions about how to change health behaviour. I describe anomalies in value-based choice that can be exploited for health promotion, and review neuroimaging evidence about the involvement of midline dopamine structures in tracking and integrating value-related information during choice. I highlight how this knowledge can bring insights to health psychology using illustrative case of healthy eating. Value-based choice is a viable model for health behaviour and opens new avenues for mechanism-focused intervention.
Stankevitz, Kayla; Dement, John; Schoenfisch, Ashley; Joyner, Julie; Clancy, Shayna M; Stroo, Marissa; Østbye, Truls
To characterize barriers to healthy eating (BHE) and physical activity (BPA) among participants in a workplace weight management intervention. Steps to health participants completed a questionnaire to ascertain barriers to physical activity and healthy eating faced. Exploratory factor analysis was used to determine the factor structure for BPA and BHE. The relationships of these factors with accelerometer data and dietary behaviors were assessed using linear regression. Barriers to physical activity included time constraints and lack of interest and motivation, and to healthy eating, lack of self-control and convenience, and lack of access to healthy foods. Higher BHE correlated with higher sugary beverage intake but not fruit and vegetable and fat intake. To improve their effectiveness, workplace weight management programs should consider addressing and reducing barriers to healthy eating and physical activity.
Melnyk, Bernadette; Kelly, Stephanie; Jacobson, Diana; Arcoleo, Kimberly; Shaibi, Gabriel
To assess the preliminary effects of a new course entitled Freshman 5 to Thrive/COPE Healthy Lifestyles on the cognitive beliefs, knowledge, mental health outcomes, healthy lifestyle choices, physical activity, and retention of college freshmen. Measures included demographics, nutrition knowledge, healthy lifestyle beliefs, healthy lifestyle perceived difficulty, healthy lifestyle choices, Beck Youth Inventories-II (anxiety, depression, anxiety, and destructive behavior), step count via pedometer, and college retention. The experimental COPE (Creating Opportunities for Personal Empowerment) group had greater intentions to live a healthy lifestyle (p = .02) versus the comparison group. COPE students also significantly increased their physical activity (p = .003) from baseline to postintervention and had a higher college retention rate than students who did not take the course. In addition, there was a significant decrease in depressive and anxiety symptoms in COPE students whose baseline scores were elevated. The Freshman 5 to Thrive Course is a promising intervention that can be used to enhance healthy lifestyle behaviors and improve mental health outcomes in college freshmen. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.
El Koussa, Maria; Atun, Rifat; Bowser, Diana; Kruk, Margaret E
Objectives The movement of skilled physicians from the public to the private sector is a key constraint to achieving universal health coverage and is currently affecting health systems worldwide. This systematic review aims to assess factors influencing physicians’ choice of workplace, and policy interventions for retaining physicians in the public sector. Methods Five literature databases were searched. Studies were included in the review if they focused on at least one of the following criteria: (i) incentives or motivators for retaining physicians in the public sector, (ii) pull factors that encouraged physicians to move to the private sector, (iii) push factors that forced physicians to leave the public sector, (iv) policy interventions or case studies that addressed physician retention in the public sector, and (v) qualitative reviews of policy interventions that were implemented in different health system settings. Results Nineteen articles met the inclusion criteria. Six major themes that affected physicians’ choice of workplace were identified including: financial incentives, career development, infrastructure and staffing, professional work environment, workload and autonomy. The majority of the studies suggested that the use of financial incentives was a motivator in retaining physicians in the public sector. The review also identified policy interventions including: regulatory controls, incentives and management reforms. Regulatory controls and incentives were the two most frequently reported policy interventions. Conclusion While factors affecting physicians’ choice of workplace are country specific, financial incentives and professional development are core factors. Other factors are highly influenced by context, and thus, it would be useful for future cross–country research to use standardized data collection tools, allowing comparison of contextual factors as well as the examination of how context affects physician retention in the public
Progress Evaluation for the Restaurant Industry Assessed by a Voluntary Marketing-Mix and Choice-Architecture Framework That Offers Strategies to Nudge American Customers toward Healthy Food Environments, 2006-2017.
Kraak, Vivica; Englund, Tessa; Misyak, Sarah; Serrano, Elena
Consumption of restaurant food and beverage products high in fat, sugar and sodium contribute to obesity and non-communicable diseases. We evaluated restaurant-sector progress to promote healthy food environments for Americans. We conducted a desk review of seven electronic databases (January 2006-January 2017) to examine restaurant strategies used to promote healthful options in the United States (U.S.). Evidence selection ( n = 84) was guided by the LEAD principles (i.e., locate, evaluate, and assemble evidence to inform decisions) and verified by data and investigator triangulation. A marketing-mix and choice-architecture framework was used to examine eight voluntary strategies (i.e., place, profile, portion, pricing, promotion, healthy default picks, priming or prompting and proximity) to evaluate progress (i.e., no, limited, some or extensive) toward 12 performance metrics based on available published evidence. The U.S. restaurant sector has made limited progress to use pricing, profile (reformulation), healthy default picks (choices), promotion (responsible marketing) and priming and prompting (information and labeling); and some progress to reduce portions. No evidence was available to assess progress for place (ambience) and proximity (positioning) to promote healthy choices during the 10-year review period. Chain and non-chain restaurants can apply comprehensive marketing-mix and nudge strategies to promote healthy food environments for customers.
Nord, Mark; Hopwood, Heather
The cost of “enough food,” estimated from the amount that low- and medium-income households in a geographic area report needing to spend to just meet their food needs, differs substantially across States and among metropolitan areas. In areas with high food costs, many food-stamp recipients are likely to have inadequate food resources to support healthy food choices.
Goracci, A; Rucci, P; Forgione, R N; Campinoti, G; Valdagno, M; Casolaro, I; Carretta, E; Bolognesi, S; Fagiolini, A
Research evidence on the effects of integrated multifaceted lifestyle interventions for depression is scanty. The aim of the present study is to report on the development, acceptability and efficacy of a standardized healthy lifestyle intervention, including exercise, eating habits, sleep hygiene and smoking cessation in preventing relapses. One hundred-sixty outpatients with recurrent unipolar depression or bipolar disorder were recruited after achieving full remission or recovery from the most recent depressive episode. Patients were randomized to 3-months of usual care or to an intervention aimed at promoting a healthy lifestyle (HLI), as an augmentation of pharmacological maintenance treatment. Usual care consisted of clinical management visits. At the end of the intervention, follow-up visits were scheduled at 3,6,9 and 12 months. During the intervention phase, 1 relapse occurred in the HLI group and 4 in the control group. Over the 12 months of follow-up, relapses were 5 in the HLI group and 16 in control group. Using an intent-to-treat approach, the overall percentage of relapses was 6/81 (7.4%) in the HLI group vs. 20/79 (25.3%) in the control group.. In a Kaplan-Meier survival analysis the risk of relapse was significantly lower in patients receiving the HLI intervention (log-rank test, p=0.003) over the 60 weeks of observation. The majority of patients assigned to HLI adhered to the program, and were highly motivated throughout the intervention. The retention rate was low because patients were recruited during the maintenance phase and the 1-year follow-up was relatively short to detect a long-term effect of HLI. The HLI program proved to be efficacious in preventing relapses. Given the absence of contraindications and its cost-effectiveness in routine practice, the use of HLI should be encouraged to promote the well-being of patients with recurrent depression. Copyright © 2016 Elsevier B.V. All rights reserved.
... important that you: Don’t smoke or drink alcohol. Eat healthy foods and get enough folic acid. Stay active. Take ... Learn more: Pregnant? Don’t Smoke! Quit Smoking Alcohol Use in Pregnancy Next ... 7 of 11 sections Take Action: Eat Healthy and Stay Active Eat healthy foods. Making healthy food choices during pregnancy can help ...
Van Gestel, L C; Kroese, F M; De Ridder, D T D
Objective The current study is a longitudinal conceptual replication and aimed to investigate the effect of a food repositioning nudge on healthy food choice in a kiosk. Design During eight weeks, sales data were collected. The former four weeks formed the baseline phase and the latter four weeks formed the nudge phase where healthy food products were repositioned at the checkout counter display, while unhealthy alternatives remained available elsewhere in the store. Main Outcome Measures The main variable of interest was the proportion of healthy food products (selected to be repositioned) sold per day. Also exit interviews were administered to gather individual level data about purchases, and awareness and opinions of the nudge. Results Results showed that the proportion of selected healthy food products in total food sales was higher in all four nudge weeks than in all four baseline weeks. Individual level data showed that more customers had bought a selected healthy food product in the nudge phase and that customers generally approved of the nudge. Conclusion The current study strengthened the empirical evidence base of repositioning healthy food products as an effective and well-accepted nudge.
Round, Jeff; Drake, Robyn; Kendall, Edward; Addicott, Rachael; Agelopoulos, Nicky; Jones, Louise
We report the use of difference in differences (DiD) methodology to evaluate a complex, system-wide healthcare intervention. We use the worked example of evaluating the Marie Curie Delivering Choice Programme (DCP) for advanced illness in a large urban healthcare economy. DiD was selected because a randomised controlled trial was not feasible. The method allows for before and after comparison of changes that occur in an intervention site with a matched control site. This enables analysts to control for the effect of the intervention in the absence of a local control. Any policy, seasonal or other confounding effects over the test period are assumed to have occurred in a balanced way at both sites. Data were obtained from primary care trusts. Outcomes were place of death, inpatient admissions, length of stay and costs. Small changes were identified between pre- and post-DCP outputs in the intervention site. The proportion of home deaths and median cost increased slightly, while the number of admissions per patient and the average length of stay per admission decreased slightly. None of these changes was statistically significant. Effects estimates were limited by small numbers accessing new services and selection bias in sample population and comparator site. In evaluating the effect of a complex healthcare intervention, the choice of analysis method and output measures is crucial. Alternatives to randomised controlled trials may be required for evaluating large scale complex interventions and the DiD approach is suitable, subject to careful selection of measured outputs and control population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Aleksandra J. Borek
Full Text Available Abstract Background Parent carers of disabled children report poor physical health and mental wellbeing. They experience high levels of stress and barriers to engagement in health-related behaviours and with ‘standard’ preventive programmes (e.g. weight loss programmes. Interventions promoting strategies to improve health and wellbeing of parent carers are needed, tailored to their specific needs and circumstances. Methods We developed a group-based health promotion intervention for parent carers by following six steps of the established Intervention Mapping approach. Parent carers co-created the intervention programme and were involved in all stages of the development and testing. We conducted a study of the intervention with a group of parent carers to examine the feasibility and acceptability. Standardised questionnaires were used to assess health and wellbeing pre and post-intervention and at 2 month follow up. Participants provided feedback after each session and took part in a focus group after the end of the programme. Results The group-based Healthy Parent Carers programme was developed to improve health and wellbeing through engagement with eight achievable behaviours (CLANGERS – Connect, Learn, be Active, take Notice, Give, Eat well, Relax, Sleep, and by promoting empowerment and resilience. The manualised intervention was delivered by two peer facilitators to a group of seven parent carers. Feedback from participants and facilitators was strongly positive. The study was not powered or designed to test effectiveness but changes in measures of participants’ wellbeing and depression were in a positive direction both at the end of the intervention and 2 months later which suggest that there may be a potential to achieve benefit. Conclusions The Healthy Parent Carers programme appears feasible and acceptable. It was valued by, and was perceived to have benefited participants. The results will underpin future refinement of the
Díaz Martínez, Ximena; Mena Bastías, Carmen; Celis-Moralesl, Carlos; Salas, Carlos; Valdivia Moral, Pedro
interventions aiming to develop healthy lifestyle behaviours at early age could be an effective way of reducing childhood obesity. to evaluate the effect of a dietary and physical activity intervention on reducing childhood obesity. 312 students took part on this 5 month intervention study. The intervention included dietary talk delivered to children and their parents in addition to 45 minutes of daily physical activity modules. Nutritional status was assessed using the Obesity Task Force criteria. Changes in dietary behaviours and physical activity were assessed using questionnaires administrated to the parents. body mass index decreased significantly post intervention (-0.2 kg.m-2), however, this reduction was driven by boys (-0.3 kg.m-2). Similarly, waist circumference shows a significant reduction in boys (-0.4 cm) but not girls. Children with overweight or obesity shows greater reductions in obesity-related traits, which were related to changes in dietary and physical activity post interventions. multidisciplinary interventions applied to children between 5 and 7 years old are effective on reducing body mass index and improving dietary and physical activity behaviours in overweight and obese children. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Becker, Mackenzie P E; Christensen, Bruce K; Cunningham, Charles E; Furimsky, Ivana; Rimas, Heather; Wilson, Fiona; Jeffs, Lisa; Bieling, Peter J; Madsen, Victoria; Chen, Yvonne Y S; Mielko, Stephanie; Zipursky, Robert B
Early intervention services (EISs) for mental illness may improve outcomes, although treatment engagement is often a problem. Incorporating patients' preferences in the design of interventions improves engagement. A discrete-choice conjoint experiment was conducted in Canada to identify EIS attributes that encourage treatment initiation. Sixteen four-level attributes were formalized into a conjoint survey, completed by patients, family members, and mental health professionals (N=562). Participants were asked which EIS option people with mental illness would contact. Latent-class analysis identified respondent classes characterized by shared preferences. Randomized first-choice simulations predicted which hypothetical options, based on attributes, would result in maximum utilization. Participants in the conventional-service class (N=241, 43%) predicted that individuals would contact traditional services (for example, hospital location and staffed by psychologists or psychiatrists). Membership was associated with being a patient or family member and being male. Participants in the convenient-service class (N=321, 57%) predicted that people would contact services promoting easy access (for example, self-referral and access from home). Membership was associated with being a professional. Both classes predicted that people would contact services that included short wait times, direct contact with professionals, patient autonomy, and psychological treatment information. The convenient-service class predicted that people would use an e-health model, whereas the conventional-service class predicted that people would use a primary care or clinic-hospital model. Provision of a range of services may maximize EIS use. Professionals may be more apt to adopt EISs in line with their beliefs regarding patient preferences. Considering several perspectives is important for service design.
Mead, Erin L; Gittelsohn, Joel; Roache, Cindy; Corriveau, André; Sharma, Sangita
Diet-related chronic diseases are highly prevalent among indigenous populations in the Canadian Arctic. A community-based, multi-institutional nutritional and lifestyle intervention-Healthy Foods North-was implemented to improve food-related psychosocial factors and behaviors among Inuit and Inuvialuit in four intervention communities (with two comparison communities) in Nunavut and the Northwest Territories, Canada, in 2008. The 12-month program was developed from theory (social cognitive theory and social ecological models), formative research, and a community participatory process. It included an environmental component to increase healthy food availability in local stores and activities consisting of community-wide and point-of-purchase interactive educational taste tests and cooking demonstrations, media (e.g., radio ads, posters, shelf labels), and events held in multiple venues, including recreation centers and schools. The intervention was evaluated using pre- and postassessments with 246 adults from intervention and 133 from comparison communities (311 women, 68 men; mean age 42.4 years; 78.3% retention rate). Outcomes included psychosocial constructs (healthy eating knowledge, self-efficacy, and behavioral intentions), frequency of healthy and unhealthy food acquisition, healthiness of commonly used food preparation methods, and body mass index (kg/m(2)). After adjustment for demographic, socioeconomic status, and body mass index variables, respondents living in intervention communities showed significant improvements in food-related self-efficacy (β = 0.15, p = .003) and intentions (β = 0.16, p = .001) compared with comparison communities. More improvements from the intervention were seen in overweight, obese, and high socioeconomic status respondents. A community-based, multilevel intervention is an effective strategy to improve psychosocial factors for healthy nutritional behavior change to reduce chronic disease in indigenous Arctic populations.
Progress Evaluation for the Restaurant Industry Assessed by a Voluntary Marketing-Mix and Choice-Architecture Framework That Offers Strategies to Nudge American Customers toward Healthy Food Environments, 2006–2017
Misyak, Sarah; Serrano, Elena
Consumption of restaurant food and beverage products high in fat, sugar and sodium contribute to obesity and non-communicable diseases. We evaluated restaurant-sector progress to promote healthy food environments for Americans. We conducted a desk review of seven electronic databases (January 2006–January 2017) to examine restaurant strategies used to promote healthful options in the United States (U.S.). Evidence selection (n = 84) was guided by the LEAD principles (i.e., locate, evaluate, and assemble evidence to inform decisions) and verified by data and investigator triangulation. A marketing-mix and choice-architecture framework was used to examine eight voluntary strategies (i.e., place, profile, portion, pricing, promotion, healthy default picks, priming or prompting and proximity) to evaluate progress (i.e., no, limited, some or extensive) toward 12 performance metrics based on available published evidence. The U.S. restaurant sector has made limited progress to use pricing, profile (reformulation), healthy default picks (choices), promotion (responsible marketing) and priming and prompting (information and labeling); and some progress to reduce portions. No evidence was available to assess progress for place (ambience) and proximity (positioning) to promote healthy choices during the 10-year review period. Chain and non-chain restaurants can apply comprehensive marketing-mix and nudge strategies to promote healthy food environments for customers. PMID:28704965
Ni Mhurchu, Cliona; Eyles, Helen; Jiang, Yannan; Blakely, Tony
There are few objective data on how nutrition labels are used in real-world shopping situations, or how they affect dietary choices and patterns. The Starlight study was a four-week randomised, controlled trial of the effects of three different types of nutrition labels on consumer food purchases: Traffic Light Labels, Health Star Rating labels, or Nutrition Information Panels (control). Smartphone technology allowed participants to scan barcodes of packaged foods and receive randomly allocated labels on their phone screen, and to record their food purchases. The study app therefore provided objectively recorded data on label viewing behaviour and food purchases over a four-week period. A post-hoc analysis of trial data was undertaken to assess frequency of label use, label use by food group, and association between label use and the healthiness of packaged food products purchased. Over the four-week intervention, study participants (n = 1255) viewed nutrition labels for and/or purchased 66,915 barcoded packaged products. Labels were viewed for 23% of all purchased products, with decreasing frequency over time. Shoppers were most likely to view labels for convenience foods, cereals, snack foods, bread and bakery products, and oils. They were least likely to view labels for sugar and honey products, eggs, fish, fruit and vegetables, and meat. Products for which participants viewed the label and subsequently purchased the product during the same shopping episode were significantly healthier than products where labels were viewed but the product was not subsequently purchased: mean difference in nutrient profile score -0.90 (95% CI -1.54 to -0.26). In a secondary analysis of a nutrition labelling intervention trial, there was a significant association between label use and the healthiness of products purchased. Nutrition label use may therefore lead to healthier food purchases. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
Boddy Lynne M
Full Text Available Abstract Background Childhood obesity is a significant public health concern. Many intervention studies have attempted to combat childhood obesity, often in the absence of formative or preparatory work. This study describes the healthy eating component of the formative phase of the Children’s Health Activity and Nutrition: Get Educated! (CHANGE! project. The aim of the present study was to gather qualitative focus group and interview data regarding healthy eating particularly in relation to enabling and influencing factors, barriers and knowledge in children and adults (parents and teachers from schools within the CHANGE! programme to provide population-specific evidence to inform the subsequent intervention design. Methods Semi-structured focus group interviews were conducted with children, parents and teachers across 11 primary schools in the Wigan borough of North West England. Sixty children (N = 24 boys, 33 parents (N = 4 male and 10 teachers (N = 4 male participated in the study. Interview questions were structured around the PRECEDE phases of the PRECEDE-PROCEED model. Interviews were transcribed verbatim and analysed using the pen-profiling technique. Results The pen-profiles revealed that children’s knowledge of healthy eating was generally good, specifically many children were aware that fruit and vegetable consumption was ‘healthy’ (N = 46. Adults’ knowledge was also good, including restricting fatty foods, promoting fruit and vegetable intake, and maintaining a balanced diet. The important role parents play in children’s eating behaviours and food intake was evident. The emerging themes relating to barriers to healthy eating showed that external drivers such as advertising, the preferred sensory experience of “unhealthy” foods, and food being used as a reward may play a role in preventing healthy eating. Conclusions Data suggest that; knowledge related to diet composition was not a barrier per se to
Jones, Sandra C; Kervin, Lisa
The present study sought to determine the feasibility of an experimental research design to investigate the effects of exposure to magazine advertising on children's food choices. Children were randomized to read either a magazine with food advertisements or a magazine with no food advertisements. They then chose two food items from the intervention 'store' to eat after the session. Data were also collected on attitudes to advertising and snack food preferences. Finally, participants' parents were provided with a self-completion survey on food choices and other variables (n 24). Three vacation care centres in regional New South Wales, Australia. Children aged 5-12 years (n 47). Children in the experimental condition were more likely to choose advertised foods than those in the control group. Interestingly, the majority reported taste and healthiness as the most important factors in snack food choices; however, when faced with the actual food choice, they predominantly chose unhealthy foods (eighty-two unhealthy and only twelve healthy items were chosen). This was the first study to assess the effects on children of exposure to food advertising within the context of reading a child-targeted magazine. Importantly, even with the small sample size and venue limitations, we found that exposure to magazine advertising influenced food choices. Children's magazines are an under-researched and poorly regulated medium, with considerable potential to influence children's food choices. The present study shows that the methodology is feasible, and future studies could replicate this with larger samples.
He, Chen; Mikkelsen, Bent Egberg
Obesity and overweight among children and young people is increasing in most countries in Europe and as a result schools are increasingly taking a role in both food provision, in promoting healthy eating, and nutrition education of young people by implementing healthy policies. At the same time s...... Based Questionnaire. The results indicate that there is an association between organic food strategies and the availability of healthy meal options. But further studies are needed in order to understand the nature of this association.......Obesity and overweight among children and young people is increasing in most countries in Europe and as a result schools are increasingly taking a role in both food provision, in promoting healthy eating, and nutrition education of young people by implementing healthy policies. At the same time...... schools are implementing environmental friendly polices i.e. organic procurement strategies (Mu, 2008). It is therefore relevant to investigate the relationship between the different components of such interventions. This study carried out a survey in primary schools in Denmark and Norway through a Web...
Promoting physical activity, healthy eating and gross motor skills development among preschoolers attending childcare centers: Process evaluation of the Healthy Start-Départ Santé intervention using the RE-AIM framework.
Ward, Stéphanie; Chow, Amanda Froehlich; Humbert, M Louise; Bélanger, Mathieu; Muhajarine, Nazeem; Vatanparast, Hassan; Leis, Anne
The Healthy Start-Départ Santé intervention was developed to promote physical activity, gross motor skills and healthy eating among preschoolers attending childcare centers. This process evaluation aimed to report the reach, effectiveness, adoption, implementation and maintenance of the Healthy Start-Départ Santé intervention. The RE-AIM framework was used to guide this process evaluation. Data were collected across 140 childcare centers who received the Healthy Start-Départ Santé intervention in the provinces of Saskatchewan and New Brunswick, Canada. Quantitative data were collected through director questionnaires at 10 months and 2 years after the initial training and analyzed using descriptive statistics. Qualitative data were collected throughout the intervention. The intervention was successful in reaching a large number of childcare centres and engaging both rural and urban communities across Saskatchewan and New Brunswick. Centres reported increasing opportunities for physical activity and healthy eating, which were generally low-cost, easy and quick to implement. However, these changes were rarely transformed into formal written policies. A total of 87% of centers reported using the physical activity resource and 68% using the nutrition resource on a weekly basis. Implementation fidelity of the initial training was high. Of those centers who received the initial training, 75% participated in the mid-point booster session training. Two year post-implementation questionnaires indicated that 47% of centers were still using the Active Play Equipment kit, while 42% were still using the physical activity resource and 37% were still using the nutrition resource. Key challenges to implementation and sustainability identified during the evaluation were consistent among all of the REAIM elements. These challenges included lack of time, lack of support from childcare staff and low parental engagement. Findings from this study suggest the implementation of
Vilaro, Melissa J; Barnett, Tracey E; Mathews, Anne; Pomeranz, Jamie; Curbow, Barbara
The role of social influences on rural women's food choice is not well understood. Rural adults experience high rates of obesity and poor diet quality prompting exploration of how social factors influence food choice in this population. Semi-structured qualitative interviews were conducted with 20 women in rural North Central Florida. Women were purposively sampled and stratified by race and income. Lower income was defined as household income at or below 185% of the federal poverty level (FPL). Women at or below 185% poverty level (BPL) experienced direct social control of their eating behaviors, which occurred when social network members explicitly regulated or otherwise sanctioned eating behaviors or food choices. Women above 185% of the federal poverty level (APL) internalized social norms and self-regulated their eating behaviors to maintain healthy habits. APL women described choosing foods for health reasons whereas BPL women offered a variety of reasons including taste, convenience, family history, price, health, and routine. Findings suggest that women in different income groups have different social influences working to help them regulate eating behaviors as well as diverse priorities influencing their food choices. Future interventions to promote healthy eating may be more effective by incorporating social network members and framing intervention messages so they are consistent with priorities. Copyright © 2016 Elsevier Ltd. All rights reserved.
Berglund, B.; Lindvall, T.; Maansson, L.G.
The Healthy Buildings '88 Conference focuses on the technical solutions and functional requirements contributing to Healthy Buildings for people to live and work in. The main object of the Conference is to give architects, consultants, real-estate owners and manufacturers of building materials recommendations on choice of materials and choice of systems and on how to combine materials and systems. The program includes overview lectures, plenary symposia with invited speakers, workshops, poster presentations and an exhibition of scientific, educational and technical material. One part of the conference is devoted to the problem of radon in residential buildings
Dumas, Audrée-Anne; Lemieux, Simone; Lapointe, Annie; Provencher, Véronique; Robitaille, Julie; Desroches, Sophie
Low adherence to dietary guidelines and a concurrent rise of obesity-related chronic diseases emphasize the need for effective interventions to promote healthy eating. There is growing recognition that behavior change interventions should draw on theories of behavior change. Online interventions grounded in theory lead to increased effectiveness for health behavior change; however, few theory-driven social media-based health promotion interventions have been described in the literature. The objective of this study was to describe the application of the Intervention Mapping (IM) protocol to develop an evidence-informed blog to promote healthy eating among French-Canadian mothers of preschool and school-aged children. The following six steps of the IM protocol were performed. In Step 1, a preliminary needs assessment included a literature search on theoretical domains predicting Vegetables and Fruits intakes and Milk and Alternatives intakes in adults (ie, knowledge, beliefs about capabilities, beliefs about consequences, intention/goals) and a qualitative study including focus groups to identify female Internet users' perceptions of their use of healthy eating blogs. In Step 2, two behavioral outcomes were selected (ie, increase daily intakes of Vegetables and Fruits and Milk and Alternatives of mothers to reach Canadian dietary recommendations) and subsequently divided into six performance objectives inspired by national and international dietary recommendations such as planning for healthy meals. A matrix of change objectives was then created by crossing performance objectives with theoretical domains predicting Vegetables and Fruits intakes and Milk and Alternatives intakes in adults. Step 3 consisted of selecting theory-based intervention methods (eg, modeling and goal setting) and translating them into practical applications for the context of a dietary intervention delivered through a blog. A 6-month intervention was developed in Step 4 in which we aimed to
Background Two strategies commonly recommended to improve population diets include food labels and food taxes/subsidies. The aim of this study was to examine the effects of both strategies separately and in combination. Findings An experiment with a 3x3 factorial design was conducted, including: three levels of price reduction (10%; 25%; and 50%) x three labels (‘special offer’, ‘healthy choice’ and ‘special offer & healthy choice’) on healthy foods defined following the Choices front-of-pack nutrition label. N = 109 participants completed the experiment by conducting a typical weekly shop for their household at a three-dimensional web-based supermarket. Data were analysed using analysis of covariance. Participants receiving a 50% price discount purchased significantly more healthy foods for their household in a typical weekly shop than the 10% discount (+8.7 items; 95%CI = 3.8-13.6) and the 25% discount group (+7.7 items; 95%CI = 2.74 – 12.6). However, the proportion of healthy foods was not significantly higher and the discounts lead to an increased amount of energy purchased. No significant effects of the labels were found. Conclusion This study brings some relevant insights into the effects of price discounts on healthier foods coupled with different labels and shows that price effects over shadowed food labels. However, price discounts seem to have ambiguous effects; they do encourage the purchase of healthy products, but also lead to increased energy purchases. More research is needed to examine how pricing strategies can work in directing consumers towards interchanging unhealthier options for healthier alternatives. PMID:23680347
Hartmann, Christina; Dohle, Simone; Siegrist, Michael
This study focuses on body weight motivation based on self-determination theory. The impact of body weight motivation on longitudinal changes in food choices, recreational physical activity and body mass index was explored. A sample of adults (N = 2917, 47% men), randomly selected from the telephone book, completed a questionnaire in two consecutive years (2012, 2013), self-reporting food choices, recreational physical activity and body weight motivation. Types of body weight motivation at T1 (autonomous regulation, introjected regulation, and external regulation) were tested with regard to their predictive potential for changes in food choices, recreational physical activity and body mass index (BMI). Autonomous motivation predicted improvements in food choices and long-term adherence to vigorous recreational physical activity in both genders. Introjected motivation predicted long-term adherence to vigorous recreational physical activity only in women. External motivation predicted negative changes in food choices; however, the type of body weight motivation had no impact on BMI in overweight adults in the long term. Autonomous goal-setting regarding body weight seems to be substantial for healthy food choices and adherence to recreational physical activity.
Wolfenden, Luke; Nathan, Nicole; Williams, Christopher M; Delaney, Tessa; Reilly, Kathryn L; Freund, Megan; Gillham, Karen; Sutherland, Rachel; Bell, Andrew C; Campbell, Libby; Yoong, Serene; Wyse, Rebecca; Janssen, Lisa M; Preece, Sarah; Asmar, Melanie; Wiggers, John
The implementation of healthy school canteen policies has been recommended as a strategy to help prevent unhealthy eating and excessive weight gain. Internationally, research suggests that schools often fail to implement practices consistent with healthy school canteen policies. Without a population wide implementation, the potential benefits of these policies will not be realised. The aim of this trial is to assess the effectiveness of an implementation intervention in increasing school canteen practices consistent with a healthy canteen policy of the New South Wales (NSW), Australia, government known as the 'Fresh Tastes @ School NSW Healthy School Canteen Strategy'. The parallel randomised trial will be conducted in 70 primary schools located in the Hunter region of New South Wales, Australia. Schools will be eligible to participate if they are not currently meeting key components of the healthy canteen policy. Schools will be randomly allocated after baseline data collection in a 1:1 ratio to either an intervention or control group using a computerised random number function in Microsoft Excel. Thirty-five schools will be selected to receive a multi-component intervention including implementation support from research staff, staff training, resources, recognition and incentives, consensus and leadership strategies, follow-up support and implementation feedback. The 35 schools allocated to the control group will not receive any intervention support as part of the research trial. The primary outcome measures will be i) the proportion of schools with a canteen menu that does not contain foods or beverages restricted from regular sale ('red' and 'banned' items) and ii) the proportion of schools where healthy canteen items ('green' items) represent the majority (>50%) of products listed on the menu. Outcome data will be collected via a comprehensive menu audit, conducted by dietitians blind to group allocation. Intervention effectiveness will be assessed using
Full Text Available Background and Objectives: Nutrition is important during childhood for growth and to help prevent infections and other diseases and educational interventions will be effective. The aim of this study was to examine the effect of educational intervention on promoting healthy eating behaviors among primary school students of Kermanshah City, Iran. Materials and Methods: In this semi-experimental study, 135 primary school students were randomly allocated into intervention and control groups. Data were collected using a valid and reliable questionnaire before and after the intervention in the areas of knowledge, attitude, practice and demographic variables. Data were analyzed using Chi-square, and paired t test with the SPSS-13 software. Results: Results showed that after the educational intervention the mean scores of knowledge, attitudes and practice were increased significantly in the experimental group (P0.05. Conclusions: The results of this study showed that the educational intervention was effective in creating positive changes in knowledge, attitude and especially behaviors of the students about healthy eating. According to the appropriate education in schools and low-cost and effective nutritional education, the need to extend this type of training programs seems necessary.
Progress Evaluation for the Restaurant Industry Assessed by a Voluntary Marketing-Mix and Choice-Architecture Framework That Offers Strategies to Nudge American Customers toward Healthy Food Environments, 2006–2017
Full Text Available Consumption of restaurant food and beverage products high in fat, sugar and sodium contribute to obesity and non-communicable diseases. We evaluated restaurant-sector progress to promote healthy food environments for Americans. We conducted a desk review of seven electronic databases (January 2006–January 2017 to examine restaurant strategies used to promote healthful options in the United States (U.S.. Evidence selection (n = 84 was guided by the LEAD principles (i.e., locate, evaluate, and assemble evidence to inform decisions and verified by data and investigator triangulation. A marketing-mix and choice-architecture framework was used to examine eight voluntary strategies (i.e., place, profile, portion, pricing, promotion, healthy default picks, priming or prompting and proximity to evaluate progress (i.e., no, limited, some or extensive toward 12 performance metrics based on available published evidence. The U.S. restaurant sector has made limited progress to use pricing, profile (reformulation, healthy default picks (choices, promotion (responsible marketing and priming and prompting (information and labeling; and some progress to reduce portions. No evidence was available to assess progress for place (ambience and proximity (positioning to promote healthy choices during the 10-year review period. Chain and non-chain restaurants can apply comprehensive marketing-mix and nudge strategies to promote healthy food environments for customers.
Full Text Available AbstractINTRODUCTION: Lifelong behavior and risk factors of chronic diseases extend from earlylife to adulthood. It seems that dietary habits and unhealthy food consumption, as well aspassive smoking play an important role in the development of such diseases. Multiplestudies have shown that healthy lifestyle education in preschool children improves theirknowledge, attitude and practice about healthy lifestyle. This study was conducted toevaluate the effect of lifestyle education with educational posters in daycare centers onpreschool children.METHODS: In an interventional study, 250 preschool children were selected via 2-stagerandom cluster sampling and taught tips on healthy lifestyle via educational posters. Theirknowledge on healthy lifestyle was assessed before and after (1 week and 3 monthseducation via a picture-questionnaire, and their practice and behavior were assessed beforeand after education via their favorite choice of snack in daycare centers. Collected datawere analyzed using SPSS13 by paired t-test and Man Whitney test.RESULTS: The knowledge and practice scores of the studied subjects improvedsignificantly one week after intervention compared with baseline, and persisted until the thirdmonth after education.DISCUSSION: Healthy lifestyle education via poster for preschool children can significantlyimprove their knowledge and practice towards healthy lifestyle.Keywords • Healthy life style • Education • Preschool children
Llauradó, Elisabet; Aceves-Martins, Magaly; Tarro, Lucia; Papell-Garcia, Ignasi; Puiggròs, Francesc; Prades-Tena, Jordi; Kettner, Helle; Arola, Lluis; Giralt, Montse; Solà, Rosa
Sustainability capacity, always considered a challenge, is the ability to maintain effective long-term intervention in a community. The aim of the study was to improve the sustainability capacity of effective "Som la Pera," a school-based, peer-led, social-marketing intervention that encourages healthy diet and physical activity, in low socioeconomic adolescents from Spain. The sustainability capacity was analyzed by a "programme sustainability assessment tool (PSAT)" comprising eight domains: political support, funding stability, partnerships, organizational capacity, programme evaluation, programme adaptation, communications, and strategic planning. Each domain was evaluated from 1 (no or to a small extent) to 7 points (to a great extent). The final score for sustainability capacity was the mean of the eight domain scores. The PSAT was assessed by nine professionals (researchers, staff members, and stakeholders) at two periods during intervention implementation: end of the first year (January 2015) and end of the second year (September 2015). At the end of the first year, strategic planning (4.43 ± 1.98) and funding stability (4.38 ± 1) were considered deficient domains, and at the end of the second year, these domains had improved by 1.67 points (p =.043) and 0.59 points (p = .159), respectively. The funding stability increase was not significant because only one of the five specific items, "policies implemented to ensure sustained funding," improved by 1.08 points (p = .036). The sustainability capacity final score was 5.93 ± 1.13. The sustainability capacity assessment during the intervention allows its improvement before the programme expires, ensuring the long-term implementation of the "Som la Pera" intervention programme to encourage healthy lifestyles in adolescents. © Society of Behavioral Medicine 2018. All rights reserved. For permissions, please e-mail: email@example.com.
Gray, Heewon Lee; Contento, Isobel R.; Koch, Pamela A.
This study investigates the link between process evaluation components and the outcomes of a school-based nutrition curriculum intervention, ‘Choice, Control and Change’. Ten New York City public middle schools were recruited and randomly assigned into intervention or control condition. The curriculum was to improve sixth to seventh grade students’ energy balance related behaviors, based on social cognitive and self-determination theories, and implemented during the 2006–2007 school year (n = 1136). Behaviors and psychosocial variables were measured by self-reported questionnaires. Process components were evaluated with classroom observations, teacher interviews, and a student questionnaire. Using ‘Teacher Implementation’ (dose delivered) and ‘Student Reception’ (dose received) process data; intervention group was further categorized into medium- and high-implementation groups. Analysis of covariance revealed that, compared with control group, only high-implementation group showed significant improvement in students’ behavior and psychosocial outcomes. Hierarchical linear models showed that ‘Teacher Implementation’ and ‘Student Reception’ significantly predicted students’ sweetened beverage outcomes (P < 0.05). ‘Student Satisfaction’ was also greater when these implementation components were higher, and significantly associated with behavior and psychosocial outcomes (P < 0.05). Implementation process influenced the effectiveness of the ‘Choice, Control and Change’ intervention study. It is important to take into account the process components when interpreting the results of such research. PMID:25700557
Wrieden, Wendy L; Anderson, Annie S; Longbottom, Pat J; Valentine, Karen; Stead, Martine; Caraher, Martin; Lang, Tim; Gray, Bill; Dowler, Elizabeth
To evaluate the feasibility of undertaking a food skills intervention study in areas of social deprivation aimed at altering cooking confidence, food preparation methods and dietary choices. A standardised skills programme was implemented in community-based settings. Pre- (T1) and post-intervention (T2) and 6-month follow-up (T3) measures (7-day diaries and self-administered questionnaires) were undertaken in intervention and comparison groups. Eight urban communities in Scotland. One hundred and thirteen adults living in areas of social deprivation. It was clear that many subjects led fragmented lives and found commitment to intervention classes problematic. Sixty-three subjects completed the final (T3) assessments. The response to each component varied due to inability to attend sessions, illness, study requirements, employment, moving out of the area, change in circumstances, loss of interest and loss of postal questionnaires. At baseline, reported consumption of fruit and vegetables was low (mean frequency 8.1 +/- 4.78 times per week). Fruit intake increased significantly (P food skills intervention is likely to have a small but positive effect on food choice and confidence in food preparation. A full-scale randomised controlled trial in this hard-to-reach group would require a range of flexible approaches rather than a fully defined intervention, and presents challenges for trial design.
Michels, Karin B.; Bloom, Barry R.; Riccardi, Paul; Rosner, Bernard A.; Willett, Walter C.
Objectives To investigate the importance of cost and awareness of health- or disease-promoting properties of foods and meals for choices by customers of a cafeteria. Design A non-randomized intervention study. Setting A medium size cafeteria in the Harvard School of Public Health. Participants Customers of the cafeteria mainly consisting of public health students, faculty, and school staff and workers from the medical campus. Intervention The purchase of healthy foods and dishes was subsidized and their prices reduced by 20%. This promotion was accompanied by the distribution of educational material. Main Outcome Measures Change in consumption of healthy and less healthy foods. Analysis The geometric mean was used to calculate the change in consumption. Results During the intervention, we observed a 6% increase in the consumption of healthy foods (95% confidence interval [CI]; 5% to 8%), and a 2% decline in the consumption of less-healthy foods (95% CI; −1% to −4%). After the prices returned to their original levels, the consumption of healthy foods increased further to 17% (95% CI; 13% to 20%) and a 2% decline in the consumption of less-healthy foods (95% CI; % 1 to −5%) persisted. Conclusions Subsidizing healthful meals and educating consumers about the importance of a healthy diet can result in a modest increase in the selection of healthy foods and meals that can be maintained beyond the periods of subsidy and promotion. PMID:18460476
Lopez-Dicastillo, O; Grande, G; Callery, P
Behaviours regarding food and activity are learned during childhood and continue throughout life. Children can be very important agents in making decisions concerning their own well-being and care and their perspective is essential to understanding how they and/or others make choices for them to achieve a healthy lifestyle. However, their perspectives remain under-researched. This study provides an insight into school children's own perspectives, behaviours and contribution to food and activity choices. The paper reports on the findings from an ethnographic study with 38 Spanish children aged 5-7 years. Information was obtained through participant observations, diaries kept by children and group interviews. Data were analysed using techniques of analytical induction and constant comparison. The children who took part in this study described choices about activities with enthusiasm. Children saw activity as a way of learning new things, mastering skills and socializing. They were willing to try and experience new activities and games. However, the activities performed depended on parents' agendas and security issues. In contrast, children reported less interest in and active involvement in food choices. They contributed to family food choices indirectly through the expression of their preferences, not wanting to eat what they disliked or tasting new foods. Children had strong preferences and motivations, particularly about activities which could be harnessed in interventions to prevent obesity and promote healthy diet and activity. Parental involvement and commitment is also important both to encourage exercise according to children's interests and active informed food choices, including introduction to unfamiliar foods. © 2012 Blackwell Publishing Ltd.
Ziauddeen, Nida; Almiron-Roig, Eva; Penney, Tarra L; Nicholson, Sonja; Kirk, Sara F L; Page, Polly
Eating location has been linked with variations in diet quality including the consumption of low-nutrient energy-dense food, which is a recognised risk factor for obesity. Cross-sectional data from 4736 adults aged 19 years and over from Years 1-6 of the UK National Diet and Nutrition Survey (NDNS) Rolling Programme (RP) (2008-2014) were used to explore food consumption patterns by eating location. Eating location was categorized as home, work, leisure places, food outlets and "on the go". Foods were classified into two groups: core (included in the principal food groups and considered important/acceptable within a healthy diet) and non-core (all other foods). Out of 97,748 eating occasions reported, the most common was home (67-90% of eating occasions). Leisure places, food outlets and "on the go" combined contributed more energy from non-core (30%) than from core food (18%). Analyses of modulating factors revealed that sex, income, frequency of eating out and frequency of drinking were significant factors affecting consumption patterns ( p eating patterns, behaviours and resulting diet quality vary by location. Public health interventions should focus on availability and access to healthy foods, promotion of healthy food choices and behaviours across multiple locations, environments and contexts for food consumption.
Daniela Schneid Schuh
Full Text Available Abstract Background: Schools have become a key figure for the promotion of health and obesity interventions, bringing the development of critical awareness to the construction and promotion of a healthy diet, physical activity, and the monitoring of the nutritional status in childhood and adolescence. Objectives: To describe a study protocol to evaluate the effectiveness of an intervention designed to improve knowledge of food choices in the school environment. Methods: This is a cluster-randomized, parallel, two-arm study conducted in public elementary and middle schools in Brazil. Participants will be children and adolescents between the ages of 5 and 15 years, from both genders. The interventions will be focusing on changes in lifestyle, physical activities and nutritional education. Intervention activities will occur monthly in the school’s multimedia room or sports court. The control group arm will receive usual recommendations by the school. The primary outcome variable will be anthropometric measures, such as body mass index percentiles and levels of physical activity by the International Physical Activity Questionnaire. Results: We expect that after the study children will increase the ingestion of fresh food, reduce excessive consumption of sugary and processed foods, and reduce the hours of sedentary activities. Conclusion: The purpose of starting the dietary intervention at this stage of life is to develop a knowledge that will enable for healthy choices, providing opportunities for a better future for this population.
Every person has a stake in environmental public health. As the environment deteriorates, so does the physical and mental health of the people within it. Healthy places are those designed and built to improve the quality of life for all people who live, work, worship, learn, and play within their borders -- where every person is free to make choices amid a variety of healthy, available, accessible, and affordable options. The CDC recognizes significant health issues and places that are vital in developing the Healthy Places program and provides examples in this report.
Roy, Virginie; Rivard, Marie-Claude; Trudeau, François
Around the world, various interventions have been developed to encourage the adoption of healthy lifestyles, particularly nutrition and physical activity. Physical, political, economic and socio-cultural environments have a major influence on individual attitudes in relation to healthy lifestyle. However, stakeholders with the greatest impact on improving these environments are not always well informed about the theory and their roles on the creation of environments favourable to healthy lifestyles. Various stakeholders from the province of Quebec were therefore invited to attend training sessions in order to prepare them to act on these four environments. 1) To describe the perceptions of the stakeholders who attended these sessions concerning the content and teaching methods and 2) to identify stakeholders’ changes of perceptions and practices following the training session. Twelve (12) focus groups and 52 individual interviews were conducted across Quebec with stakeholders who attended a training session. Our results indicate increased awareness of stakeholders on the importance of their role but also the need to more precisely target those aspects requiring increased awareness. A content better suited to the level of expertise is therefore proposed to maximize the benefits of these training sessions. Training sessions must be addressed to influential stakeholders with a limited knowledge on the subject, which is often the case for municipal decision-makers known to play a major role in promoting environments favourable to healthy eating and physical activity.
Murphy, James G; Correia, Christopher J; Colby, Suzanne M; Vuchinich, Rudy E
Behavioral theories of choice predict that substance use is partly a function of the relative value of drugs in relation to other available reinforcers. This study evaluated this hypothesis in the context of predicting drinking outcomes following an alcohol abuse intervention. Participants (N = 54, 69% female, 31% male) were college student heavy drinkers who completed a single-session motivational intervention. Students completed a baseline measure of substance-related and substance-free activity participation and enjoyment. Only women showed a significant reduction in drinking at the 6-month follow-up, and the ratio of substance-related to substance-free reinforcement accounted for unique variance in their drinking outcomes. Women who at baseline derived a smaller proportion of their total reinforcement from substance use showed lower levels of follow-up drinking, even after the authors controlled for baseline drinking level. Male and female participants who reduced their drinking showed increased proportional reinforcement from substance-free activities. Copyright 2005 APA, all rights reserved.
O'Brien, O A; McCarthy, M; Gibney, E R; McAuliffe, F M
Overweight and obesity are associated with increased risk of adverse maternal and fetal outcomes. However, the actuality of delivering effective lifestyle interventions in clinical practice is hampered by a high demand for resources. The use of technology to assist lifestyle interventions needs to be explored as a valid method of reducing strain on resources, and enhancing the effectiveness and population reach of interventions. The aim was to systematically review the literature on the use of technology-supported lifestyle interventions for healthy pregnant women and their impact on maternal outcomes. Online databases and registries were searched in March 2013. Primary outcomes of selected English language studies were fasting maternal glucose, incidence of gestational diabetes mellitus (GDM) and maternal gestational weight gain. Secondary outcomes were intervention uptake and acceptance, and dietary or physical activity modification. Studies whose subjects were diagnosed with GDM prior to intervention were excluded. The minimal number of eligible studies and varying outcomes precluded formal meta-analysis of the data. Initially, 203 articles were identified and screened. Seven articles, including five randomised controlled trials, met inclusion criteria for the current review. Results demonstrate several potential benefits associated with technology-supported interventions in pregnancy, despite minimal search results. Although communication technology holds potential as a safe therapeutic tool for the support of lifestyle interventions in pregnancy, there is a paucity of data on its effectiveness. Further RCTs examining the effectiveness of communication technology are required, particularly among those most likely to benefit from lifestyle interventions, such as overweight and obese pregnant women.
Hjerkinn, E M; Sandvik, L; Hjermann, I; Arnesen, H
The aim was to study the effect of a 5-year diet intervention on 24-year mortality in middle aged men with combined hyperlipidaemia. We studied 104 initially healthy men (in 1972) aged 40-49 years with baseline values of total serum cholesterol >6.45 mmol L-1 and fasting triglycerides >2.55 mmol L-1, within the randomized diet and smoking cessation trial of the Oslo study (n = 1232). The participants were randomized to a 5-year diet intervention or a control group. The diet consisted of a traditional lipid-lowering diet with emphasis on reduction of saturated fat, total caloric intake and body weight. The groups were initially well balanced with regard to traditional risk factors for mortality. Thirty-three subjects died during the 24-year observation period [17 of cardiovascular disease (CVD) and 12 of cancer]. In the diet intervention group, mortality was 51% lower (RR = 0.49, 95% CI 0.22-0.91, P = 0.022) as compared with the control group. This difference remained significant in a Cox regression analysis after adjusting for age and smoking status (RR = 0.47, 95% CI 0.23-0.96, P = 0.038). This study indicates that the investigated 5-year diet intervention significantly reduces late mortality in healthy middle-aged men with combined hyperlipidaemia.
Crookes, Danielle M; Shelton, Rachel C; Tehranifar, Parisa; Aycinena, Corina; Gaffney, Ann Ogden; Koch, Pam; Contento, Isobel R; Greenlee, Heather
Little is known about Latina breast cancer survivors' social networks or their perceived social support to achieve and maintain a healthy diet. This paper describes the social networks and perceived support for healthy eating in a sample of breast cancer survivors of predominantly Dominican descent living in New York City. Spanish-speaking Latina breast cancer survivors enrolled in a randomized controlled trial of a culturally tailored dietary intervention. Social networks were assessed using Cohen's Social Network Index and a modified General Social Survey Social Networks Module that included assessments of shared health promoting behaviors. Perceived social support from family and friends for healthy, food-related behaviors was assessed. Participants' networks consisted predominantly of family and friends. Family members were more likely than other individuals to be identified as close network members. Participants were more likely to share food-related activities than exercise activities with close network members. Perceived social support for healthy eating was high, although perceived support from spouses and children was higher than support from friends. Despite high levels of perceived support, family was also identified as a barrier to eating healthy foods by nearly half of women. Although friends are part of Latina breast cancer survivors' social networks, spouses and children may provide greater support for healthy eating than friends. Involving family members in dietary interventions for Latina breast cancer survivors may tap into positive sources of support for women, which could facilitate uptake and maintenance of healthy eating behaviors.
Wetherill, Marianna S; Williams, Mary B; Hartwell, Micah L; Salvatore, Alicia L; Jacob, Tvli; Cannady, Tamela K; Standridge, Joy; Fox, Jill; Spiegel, Jennifer; Anderson, Natia; Jernigan, Valarie Blue Bird
In rural American Indian (AI) communities, access to affordable, healthy foods is often limited. Understanding AI food choice considerations when selecting foods, such as sensory appeal, cost, or health, is an important yet understudied topic for eliminating persistent AI health disparities. In partnership with the Chickasaw Nation and Choctaw Nation of Oklahoma, we administered a modified version of the Food Choice Values (FCV) Questionnaire to a cross-sectional sample of 83 AI patrons shopping at tribally-owned convenience stores ≥3 times per week. The FCV Questionnaire uses 25 items to assess eight FCV subscales related to buying and eating food, including sensory appeal; safety; accessibility; convenience; health/weight control; organic; tradition; and comfort. We compared mean scores for each FCV subscale by demographic groups using t-tests and ANOVA. We used confirmatory factor analysis (CFA) to examine how well the data from this population fit FCV subscale constructs. We then used cluster analysis, MANOVA, and discriminant analysis to characterize distinct segments of the population based on patterns of FCV endorsement. Appeal, safety, and access FCVs were most strongly endorsed across the sample. Prioritization of FCVs varied by age, gender, income, and education. Our cluster analysis identified four groups, or segments, each with distinct patterns of FCV endorsement: limited endorsement of any FCVs (23.3%); safety and sensory appeal (32.9%); health/weight control (17.8%); and broad endorsement of FCVs (26.0%). These groups varied by age and employment status. Findings from this analysis informed the design and implementation of a healthy retail intervention comprised of new healthful foods and beverages, product placement and marketing strategies within four tribally-owned and operated convenience stores. Public health interventions aimed at reducing nutrition-related disparities in rural AI populations may benefit from assessing food choice
Bédard, Alexandra; Goulet, Julie; Riverin, Mélissa; Lamarche, Benoît; Lemieux, Simone
It is expected that a dietary intervention based on the traditional Mediterranean food pattern should be associated with a reduction in fast-food consumption but this has never been tested before. We assessed the impact of a 12-week dietary intervention, promoting the adoption of a Mediterranean food pattern, on fast-food consumption among seventy-one healthy women aged between 30 and 65 years. The dietary intervention consisted of two group sessions and seven individual sessions with a dietitian. To determine the Mediterranean dietary score (MedScore) and fast-food consumption, an FFQ was administered. During the 12-week intervention, the MedScore significantly increased (from 21.1 (SD 3.6) units at baseline to 28.6 (SD 4.4) units at week 12, P food consumption significantly decreased (from 51.7 (SD 46.4) g/d at baseline to 20.5 (SD 18.2) g/d at week 12, P food at baseline decreased their fast-food consumption to the most (r - 0.50, P food consumption changes, it was found that only the subgroup of women which increased the most their MedScore and decreased the most their fast-food consumption experienced a significant decrease in BMI (P food pattern led to a decrease in fast-food consumption among healthy women even if it was not a specific target of the intervention. Dietary strategies for increasing intake of healthy foods may be a useful approach for decreasing intake of less healthy foods.
Jones, Megan; Taylor Lynch, Katherine; Kass, Andrea E; Burrows, Amanda; Williams, Joanne; Wilfley, Denise E; Taylor, C Barr
Given the rising rates of obesity in children and adolescents, developing evidence-based weight loss or weight maintenance interventions that can be widely disseminated, well implemented, and are highly scalable is a public health necessity. Such interventions should ensure that adolescents establish healthy weight regulation practices while also reducing eating disorder risk. This study describes an online program, StayingFit, which has two tracks for universal and targeted delivery and was designed to enhance healthy living skills, encourage healthy weight regulation, and improve weight/shape concerns among high school adolescents. Ninth grade students in two high schools in the San Francisco Bay area and in St Louis were invited to participate. Students who were overweight (body mass index [BMI] >85th percentile) were offered the weight management track of StayingFit; students who were normal weight were offered the healthy habits track. The 12-session program included a monitored discussion group and interactive self-monitoring logs. Measures completed pre- and post-intervention included self-report height and weight, used to calculate BMI percentile for age and sex and standardized BMI (zBMI), Youth Risk Behavior Survey (YRBS) nutrition data, the Weight Concerns Scale, and the Center for Epidemiological Studies Depression Scale. A total of 336 students provided informed consent and were included in the analyses. The racial breakdown of the sample was as follows: 46.7% (157/336) multiracial/other, 31.0% (104/336) Caucasian, 16.7% (56/336) African American, and 5.7% (19/336) did not specify; 43.5% (146/336) of students identified as Hispanic/Latino. BMI percentile and zBMI significantly decreased among students in the weight management track. BMI percentile and zBMI did not significantly change among students in the healthy habits track, demonstrating that these students maintained their weight. Weight/shape concerns significantly decreased among participants in
Dalma, A.; Veloudaki, A.; Petralias, A.; Mitraka, K.; Zota, D.; Kastorini, C.-M.; Yannakoulia, M.; Linos, A.
Introduction: Aiming at reducing the rates of food insecurity and promoting healthy diet for children and adolescents, we designed and implemented the Program on Food Aid and Promotion of Healthy Nutrition-DIATROFI, a school-based intervention program including the daily provision of a free healthy mid-day meal in disadvantaged areas across…
Wu, Yelena P; Yi, Jaehee; McClellan, Jessica; Kim, Jonghee; Tian, Tian; Grahmann, Bridget; Kirchhoff, Anne C; Holton, Avery; Wright, Jennifer
This study uses qualitative methods to identify barriers to and facilitators of exercise and healthy eating among adolescent and young adult (AYA) cancer survivors (survivors currently aged 18-39 years and diagnosed with cancer anytime in their lives), as reported by survivors and their primary supporters. Survivors (M(age) = 27.6 years, SD = 6.6 years) had completed active cancer therapy. Survivors and supporters (i.e., nominated by survivors as someone who was a main source of support) attended separate focus group sessions (five survivor focus groups, five supporter focus groups) and were asked to complete a self-reported questionnaire assessing demographic and cancer history and engagement in exercise and healthy eating. In total, 25 survivors and 19 supporters participated. The three overarching themes identified were barriers to exercise and healthy eating (e.g., lack of resources, negative thoughts and feelings, negative social and environmental influences), facilitators of exercise and healthy eating (e.g., cognitive motivators, tools for health behavior implementation, social relationships), and intervention implications (e.g., informational needs, desire for social support). AYA cancer survivors and their supporters identified barriers to and facilitators of healthy lifestyle behaviors, which should be considered when designing interventions to improve the long-term health of survivors.
Breslin, Gavin; Brennan, Deirdre
We describe the design of a school-based healthy lifestyle intervention for eight-year-old to nine-year-old school children from lower socio-economic backgrounds, intended to increase physical activity, decrease sedentary behaviours, reduce screen-time behaviours, encourage healthy attitudes and behaviours to nutrition, and reduce body mass index.…
Sproesser, Gudrun; Kohlbrenner, Verena; Schupp, Harald; Renner, Britta
The present study investigated self-other biases in actual eating behavior based on the observation of three different eating situations. To capture the complexity of real life food choices within a well-controlled setting, an ecologically valid fake food buffet with 72 different foods was employed. Sixty participants chose a healthy, a typical, and an unhealthy meal for themselves and for an average peer. We found that the typical meal for the self was more similar to the healthy than to the unhealthy meal in terms of energy content: The mean difference between the typical and healthy meals was MΔ = 1368 kJ (327 kcal) as compared to a mean difference between the typical and unhealthy meals of MΔ = 3075 kJ (735 kcal). Moreover, there was evidence that people apply asymmetrical standards for themselves and others: Participants chose more energy for a peer than for themselves (M = 4983 kJ or 1191 kcal on average for the peers' meals vs. M = 3929 kJ or 939 kcal on average for the own meals) and more high-caloric food items for a typical meal, indicating a self-other bias. This comparatively positive self-view is in stark contrast to epidemiological data indicating overall unhealthy eating habits and demands further examination of its consequences for behavior change.
Ziauddeen, Nida; Penney, Tarra L.; Nicholson, Sonja; Page, Polly
Eating location has been linked with variations in diet quality including the consumption of low-nutrient energy-dense food, which is a recognised risk factor for obesity. Cross-sectional data from 4736 adults aged 19 years and over from Years 1–6 of the UK National Diet and Nutrition Survey (NDNS) Rolling Programme (RP) (2008–2014) were used to explore food consumption patterns by eating location. Eating location was categorized as home, work, leisure places, food outlets and “on the go”. Foods were classified into two groups: core (included in the principal food groups and considered important/acceptable within a healthy diet) and non-core (all other foods). Out of 97,748 eating occasions reported, the most common was home (67–90% of eating occasions). Leisure places, food outlets and “on the go” combined contributed more energy from non-core (30%) than from core food (18%). Analyses of modulating factors revealed that sex, income, frequency of eating out and frequency of drinking were significant factors affecting consumption patterns (p diet quality vary by location. Public health interventions should focus on availability and access to healthy foods, promotion of healthy food choices and behaviours across multiple locations, environments and contexts for food consumption. PMID:29207469
Leia M. Minaker; Meghan Lynch; Brian E. Cook; Catherine L. Mah
Introduction: Population health interventions in the retail food environment, such as corner store interventions, aim to influence the kind of cues consumers receive so that they are more often directed toward healthier options. Research that addresses financial aspects of retail interventions, particularly using outcome measures such as store sales that are central to retail decision making, is limited. This study explored store sales over time and across product categories during a healthy ...
Allès, B; Péneau, S; Kesse-Guyot, E; Baudry, J; Hercberg, S; Méjean, C
Sustainability has become a greater concern among consumers that may influence their dietary intake. Only a few studies investigated the relationship between sustainable food choice motives and diet and they focused on specific food groups. This cross-sectional study aimed to assess the associations between food choice motives during purchasing, with a focus on sustainability, and dietary patterns in a large sample of French adults. Food choice motives were collected in 31,842 adults from the NutriNet-Santé study, using a validated 63 items questionnaire gathered into 9 dimension scores: ethics and environment, traditional and local production, taste, price, environmental limitation (i.e. not buying a food for environmental concerns), health, convenience, innovation and absence of contaminants. Dietary intake was assessed using at least three web-based 24-h food records. Three dietary patterns were obtained through factor analysis using principal component analysis. The associations between food choice motive dimension scores and dietary patterns were assessed using linear regression models, stratifying by sex. Individuals were more likely to have a "healthy diet" when they were more concerned by not buying a food for environmental concerns (only for 3 rd tertile versus 1 st tertile β women =0.18, 95% CI=0.15-0.20, β men =0.20 95% CI=(0.15-0.25)), ethics and environment (women only, β=0.05, 95% CI=0.02-0.08), absence of contaminants (women only, β=0.05, 95% CI=0.01-0.07), local production (women only, β=0.08, 95% CI=0.04-0.11), health (women only) and innovation (men only), and when they were less concerned by price. Individuals were also less likely to have traditional or western diets when they gave importance to food choice motive dimensions related to sustainability. Individuals, especially women, having higher concerns about food sustainability dimensions such as ethics and environment and local production, appear to have a healthier diet. Further
Yamauchi, Keiko; Katayama, Tomomi; Yamauchi, Takahiro; Kotani, Kazuhiko; Tsuzaki, Kokoro; Takahashi, Kaoru; Sakane, Naoki
The portion size of food is a determinant of energy intake, linking with obese traits. A healthy plate for portion control has recently been made in a Japanese style. The aim of the current study was to assess the efficacy of a lifestyle intervention program using the Japanese-style healthy plate on weight reduction in overweight and obese diabetic Japanese subjects. We randomized overweight and obese diabetic subjects (n = 19, 10 women) into an intervention group including educational classes on lifestyle modification incorporating the healthy plate (n = 10) or a waiting-list control group (n = 9). The intervention period was three months, and the educational classes using the healthy plate were conducted monthly in a group session for the intervention group. The body weight, blood glycemic and metabolic measures, and psychosocial variables were measured at the baseline and after the 3-month intervention in both groups. The impression of the intervention was interviewed using a structured questionnaire. There was one drop-out in the control group. No adverse events were reported in the groups. Subjects in the intervention group had a greater weight change from baseline to the end of the 3-month intervention period (-3.7 +/- 2.5 [SD] kg in the intervention group vs. -0.1 +/- 1.4 kg in the control group, P = 0.002). Most subjects recorded that the use of a healthy plate could be recommended to other people. The lifestyle intervention program using the Japanese-style healthy plate, which was developed for portion control, may effectively reduce body weight in overweight and obese diabetic subjects in Japan. Further studies are needed to establish the efficacy of this methodology on weight management.
Van Cauwenberghe, Eveline; Maes, Lea; Spittaels, Heleen; van Lenthe, Frank J; Brug, Johannes; Oppert, Jean-Michel; De Bourdeaudhuij, Ilse
The objective of the present review was to summarise the existing European published and 'grey' literature on the effectiveness of school-based interventions to promote a healthy diet in children (6-12 years old) and adolescents (13-18 years old). Eight electronic databases, websites and contents of key journals were systematically searched, reference lists were screened, and authors and experts in the field were contacted for studies evaluating school-based interventions promoting a healthy diet and aiming at primary prevention of obesity. The studies were included if they were published between 1 January 1990 and 31 December 2007 and reported effects on dietary behaviour or on anthropometrics. Finally, forty-two studies met the inclusion criteria: twenty-nine in children and thirteen in adolescents. In children, strong evidence of effect was found for multicomponent interventions on fruit and vegetable intakes. Limited evidence of effect was found for educational interventions on behaviour, and for environmental interventions on fruit and vegetable intakes. Interventions that specifically targeted children from lower socio-economic status groups showed limited evidence of effect on behaviour. In adolescents, moderate evidence of effect was found for educational interventions on behaviour and limited evidence of effect for multicomponent programmes on behaviour. In children and adolescents, effects on anthropometrics were often not measured, and therefore evidence was lacking or delivered inconclusive evidence. To conclude, evidence was found for the effectiveness of especially multicomponent interventions promoting a healthy diet in school-aged children in European Union countries on self-reported dietary behaviour. Evidence for effectiveness on anthropometrical obesity-related measures is lacking.
Delaney, Tessa; Wyse, Rebecca; Yoong, Sze Lin; Sutherland, Rachel; Wiggers, John; Ball, Kylie; Campbell, Karen; Rissel, Chris; Lecathelinais, Christophe; Wolfenden, Luke
Background: School canteens represent an opportune setting in which to deliver public health nutrition strategies because of their wide reach and frequent use by children. Online school-canteen ordering systems, where students order and pay for their lunch online, provide an avenue to improve healthy canteen purchases through the application of consumer-behavior strategies that have an impact on purchasing decisions. Objective: We assessed the efficacy of a consumer-behavior intervention implemented in an online school-canteen ordering system in reducing the energy, saturated fat, sugar, and sodium contents of primary student lunch orders. Design: A cluster-randomized controlled trial was conducted that involved 2714 students (aged 5-12 y) from 10 primary schools in New South Wales, Australia, who were currently using an online canteen ordering system. Schools were randomized in a 1:1 ratio to receive either the intervention (enhanced system) or the control (standard online ordering only). The intervention included consumer-behavior strategies that were integrated into the online ordering system (targeting menu labeling, healthy food availability, placement, and prompting). Results: Mean energy (difference: -567.25 kJ; 95% CI: -697.95, -436.55 kJ; P consumer-behavior intervention using an existing online canteen infrastructure to improve purchasing behavior from primary school canteens. Such an intervention may represent an appealing policy option as part of a broader government strategy to improve child public health nutrition. This trial was registered at www.anzctr.org.au as ACTRN12616000499482. © 2017 American Society for Nutrition.
Militello, Lisa K; Melnyk, Bernadette Mazurek; Hekler, Eric; Small, Leigh; Jacobson, Diana
Significant gaps exist in the published literature regarding the treatment of overweight/obesity in preschool-aged children, especially in primary care settings. Parental influence plays an important factor in the development of healthy behaviors in children, yet there is no consensus about why some behavior change intervention strategies for parents of young children are more influential and effective than others. The purpose of this secondary data analysis was to assess correlations among the study variables (healthy lifestyle beliefs, perceived difficulty, and healthy lifestyle behaviors) in parents of overweight/obese preschool children. A second aim explored if the parent's level of cognitive beliefs and perceived difficulty of engaging in healthy lifestyle behaviors correlated with text messaging cognitive behavioral support. Fifteen preschool-parent dyads from primary care clinics completed a 7-week cognitive behavioral skills building intervention. Beck's Cognitive Theory guided the intervention content, and Fogg's Behavior Model guided the implementation. The intervention was delivered using a combination of face-to-face clinic visits and ecological momentary interventions using text messaging. Supported are the interconnected relationships among the study variables, that is, parental healthy lifestyle beliefs, thoughts, and behaviors. At baseline, parental healthy lifestyle belief scores significantly correlated with perceived difficulty (rs = 0.598, p behaviors (rs = 0.545, p cognitive behavioral skills building and tailored text messaging, the need for general support via text messaging lessened, warranting additional research. Published by Elsevier Inc.
Ammerman, Alice S; Hartman, Terry; DeMarco, Molly M
The Supplemental Nutrition Assistance Program (SNAP) serves as an important nutritional safety net program for many Americans. Given its aim to use traditional economic levers to provide access to food, the SNAP program includes minimal nutritional requirements and restrictions. As food choices are influenced by more than just economic constraints, behavioral economics may offer insights and tools for altering food purchases for SNAP users. This manuscript outlines behavioral economics strategies that have potential to encourage healthier food choices within the SNAP program. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Aldrovandi, Silvio; Brown, Gordon D A; Wood, Alex M
People's evaluations in the domain of healthy eating are at least partly determined by the choice context. We systematically test reference level and rank-based models of relative comparisons against each other and explore their application to social norms nudging, an intervention that aims at influencing consumers' behavior by addressing their inaccurate beliefs about their consumption relative to the consumption of others. Study 1 finds that the rank of a product or behavior among others in the immediate comparison context, rather than its objective attributes, influences its evaluation. Study 2 finds that when a comparator is presented in isolation the same rank-based process occurs based on information retrieved from memory. Study 3 finds that telling people how their consumption ranks within a normative comparison sample increases willingness to pay for a healthy food by over 30% relative to the normal social norms intervention that tells them how they compare to the average. We conclude that social norms interventions should present rank information (e.g., "you are in the most unhealthy 10% of eaters") rather than information relative to the average (e.g., "you consume 500 calories more than the average person"). (c) 2015 APA, all rights reserved).
Michels, Karin B; Bloom, Barry R; Riccardi, Paul; Rosner, Bernard A; Willett, Walter C
To investigate the importance of cost and awareness of health- or disease-promoting properties of foods and meals for choices by customers of a cafeteria. A non-randomized intervention study. A medium size cafeteria in the Harvard School of Public Health. Customers of the cafeteria mainly consisting of public health students, faculty, and school staff and workers from the medical campus. The purchase of healthy foods and dishes was subsidized and their prices reduced by 20%. This promotion was accompanied by the distribution of educational material. Change in consumption of healthy and less healthy foods. The geometric mean was used to calculate the change in consumption. During the intervention, we observed a 6% increase in the consumption of healthy foods (95% confidence interval [CI]; 5% to 8%), and a 2% decline in the consumption of less-healthy foods (95% CI; -1% to -4%). After the prices returned to their original levels, the consumption of healthy foods increased further to 17% (95% CI; 13% to 20%) and a 2% decline in the consumption of less-healthy foods (95% CI; % 1 to -5%) persisted. Subsidizing healthful meals and educating consumers about the importance of a healthy diet can result in a modest increase in the selection of healthy foods and meals that can be maintained beyond the periods of subsidy and promotion.
The Healthy Lifestyles Programme (HeLP)--an overview of and recommendations arising from the conceptualisation and development of an innovative approach to promoting healthy lifestyles for children and their families.
Lloyd, Jenny; Wyatt, Katrina
Despite the rise in childhood obesity, there remains a paucity of evidence for effective interventions that engage children and parents sufficiently to make and sustain lifestyle behaviour change. The Healthy Lifestyles Programme (HeLP) is a school-located obesity prevention programme, which has been developed with teachers, families and healthcare professionals. The underpinning assumption in the development of HeLP was to take a relational approach to changing behaviour, building relationships with the schools, children and their families to create supportive environments for healthy lifestyle choices. Thus, HeLP was conceptualised as a complex intervention within a complex system and developed as a dynamic, evolving set of processes to support and motivate children towards healthy behaviours. The delivery methods used are highly interactive and encourage identification with and ownership of the healthy lifestyle messages so that the children are motivated to take them home to their parents and effect change within the family. We have good evidence that HeLP engages schools and children such that they want to participate in the Programme. Results from an exploratory trial showed that the Programme is feasible and acceptable and has the potential to change behaviours and affect weight status. This paper presents an overview of and recommendations arising from the conceptualization; development and evaluation of the Healthy Lifestyles Programme as part of a special issue focusing on novel approaches to the global problem of childhood obesity.
V.M.J. Kruitwagen - van de Gaar (Vivian)
markdownabstractThis thesis focused on the development and evaluation of an intervention aimed to promote a healthy lifestyle among children. This intervention – the ‘Water Campaign’- was developed with Social Marketing, aimed to decrease the consumption of sugar-sweetened beverages (SSB) among
Hanks, Andrew S; Just, David R; Smith, Laura E; Wansink, Brian
In the context of food, convenience is generally associated with less healthy foods. Given the reality of present-biased preferences, if convenience was associated with healthier foods and less healthy foods were less convenient, people would likely consume healthier foods. This study examines the application of this principle in a school lunchroom where healthier foods were made more convenient relative to less healthy foods. One of two lunch lines in a cafeteria was arranged so as to display only healthier foods and flavored milk. Trained field researchers collected purchase and consumption data before and after the conversion. Mean comparisons were used to identify differences in selection and consumption of healthier foods, less healthy foods and chocolate milk. Sales of healthier foods increased by 18% and grams of less healthy foods consumed decreased by nearly 28%. Also, healthier foods' share of total consumption increased from 33 to 36%. Lastly, we find that students increased their consumption of flavored milk, but flavored milk's share of total consumption did not increase. In a school lunchroom, a convenience line that offered only healthier food options nudged students to consume fewer unhealthy foods. This result has key implications for encouraging healthy behavior in public schools nation wide, cafeterias and other food establishments.
Marshall, Andrew T.
Two experiments examined the relationship between reward processing and impulsive choice. In Experiment 1, rats chose between a smaller-sooner (SS) reward (1 pellet, 10 s) and a larger-later (LL) reward (1, 2, and 4 pellets, 30 s). The rats then experienced concurrent variable-interval 30-s schedules with variations in reward magnitude to evaluate reward magnitude discrimination. LL choice behavior positively correlated with reward magnitude discrimination. In Experiment 2, rats chose between an SS reward (1 pellet, 10 s) and an LL reward (2 and 4 pellets, 30 s). The rats then received either a reward intervention which consisted of concurrent fixed-ratio schedules associated with different magnitudes to improve their reward magnitude discrimination, or a control task. All rats then experienced a post-intervention impulsive choice task followed by a reward magnitude discrimination task to assess intervention efficacy. The rats that received the intervention exhibited increases in post-intervention LL choice behavior, and made more responses for larger-reward magnitudes in the reward magnitude discrimination task, suggesting that the intervention heightened sensitivities to reward magnitude. The results suggest that reward magnitude discrimination plays a key role in individual differences in impulsive choice, and could be a potential target for further intervention developments. PMID:26506254
Allan, Julia L; Johnston, Marie; Campbell, Neil
Individuals with inefficient executive (higher level cognitive) function have a reduced ability to resist dietary temptation. The present study aimed to design and test a theory-based point-of-purchase intervention for coffee shops that reduced the calorie content of customers' purchases by reducing the need for executive function (EF) at the moment of choice. Key facets of EF were identified by a multidisciplinary group and used to develop a point-of-purchase intervention (signage). This intervention was evaluated in a randomized controlled trial (RCT) in a public coffee shop on consumer purchases of >20,000 snacks and drinks over 12 weeks. A sample of customers (n = 128) was recruited to complete an embedded cross-sectional study measuring EF strength, dietary intentions, typical purchases, and purchases made after exposure to the intervention. The proportion of snack purchases that were high in calorie reduced significantly (t(10) = 2.34, p = .04) in intervention weeks relative to control. High calorie drink purchases were also lower in intervention than control weeks, however, this difference was not significant (t(10) = 1.56, p = .15). On average, customers purchased items containing 66 calories customer behavior increased as EF strength decreased (β = .24, p = .03). The calorie content of cafe purchases can be lowered by reducing the cognitive demands of healthy food choice at the moment of purchase, especially in those with poor EF. Environmental changes like these have the potential to help achieve population weight control. (c) 2015 APA, all rights reserved.
Amaya-Castellanos, Claudia; Shamah-Levy, Teresa; Escalante-Izeta, Ericka; Morales-Ruán, María Del Carmen; Jiménez-Aguilar, Alejandra; Salazar-Coronel, Araceli; Uribe-Carvajal, Rebeca; Amaya-Castellanos, Alejandra
Mexico has the highest and most alarming rates of childhood obesity worldwide. A study conducted in the State of Mexico revealed that one of every three children presents overweight or obesity. The objective of this paper is to provide a step-by-step description of the design and implementation of an educational intervention to promote healthy eating and physical activity called "Healthy Recess". The educational intervention was designed using the six stages of the Health Communication Process. This methodological model allowed identifying the needs of school-age children on information and participation in activities. In order to improve the strategy, adjustments were made to the print and audiovisual materials as well as to assessment tools. Typography was modified as well as the color of the images in student's workbook and facilitator's; special effects of the videos were increased; the narration of the radio spots was improved and common words and phrases were included. The Health Communication Process is an effective tool for program planners to design interventions aimed at managing prevalent health problems such as overweight and obesity in school-age children. Copyright © 2015 Elsevier Ltd. All rights reserved.
Scourboutakos, Mary J; Mah, Catherine L; Murphy, Sarah A; Mazza, Frank N; Barrett, Nathanael; McFadden, Bill; L'Abbé, Mary R
To test the effect of a nutrition intervention that included education and 2 labeling components on students' food choices. Repeat cross-sectional study taking place on 6 dinner occasions before and 6 afterward. The study was conducted during dinner meals in a buffet-style dining hall in a university campus residence, where students paid a set price and consumed all they cared to eat. University students (n = 368 to 510) visited the cafeteria on each of the data collection dates. Fruit and vegetable consumption were encouraged; sugar-sweetened beverage consumption was discouraged using physical activity calorie equivalent labeling. Beverage choices and vegetable/fruit bar visits. Logistic regression was used to compare the proportion of student who selected each beverage, fruit, or vegetable before and after the intervention, while controlling for menu and gender as covariates. There was a significant decrease in the proportion of students selecting a sugar-sweetened beverage before vs after the intervention (49% vs 41%, respectively; P = .004) and an increase in students choosing water (43% vs 54%, respectively; P < .001). There was a significant increase in students who took fruit after the intervention (36%; P < .001) vs before (30%). The number of students visiting the vegetable bar significantly increased from 60% to 72% (P < .001). This intervention may be a way to encourage healthy dietary choices in campus dining halls. Copyright © 2017. Published by Elsevier Inc.
Nowrouzi, Behdin; Lightfoot, Nancy; Larivière, Michael; Carter, Lorraine; Rukholm, Ellen; Schinke, Robert; Belanger-Gardner, Diane
This article reports on a literature review of workplace interventions (i.e., creating healthy work environments and improving nurses' quality of work life [QWL]) aimed at managing occupational stress and burnout for nurses. A literature search was conducted using the keywords nursing, nurses, stress, distress, stress management, burnout, and intervention. All the intervention studies included in this review reported on workplace intervention strategies, mainly individual stress management and burnout interventions. Recommendations are provided to improve nurses' QWL in health care organizations through workplace health promotion programs so that nurses can be recruited and retained in rural and northern regions of Ontario. These regions have unique human resources needs due to the shortage of nurses working in primary care. © 2015 The Author(s).
The Healthy Lifestyles Programme (HeLP — An Overview of and Recommendations Arising from the Conceptualisation and Development of an Innovative Approach to Promoting Healthy Lifestyles for Children and Their Families
Full Text Available Despite the rise in childhood obesity, there remains a paucity of evidence for effective interventions that engage children and parents sufficiently to make and sustain lifestyle behaviour change. The Healthy Lifestyles Programme (HeLP is a school-located obesity prevention programme, which has been developed with teachers, families and healthcare professionals. The underpinning assumption in the development of HeLP was to take a relational approach to changing behaviour, building relationships with the schools, children and their families to create supportive environments for healthy lifestyle choices. Thus, HeLP was conceptualised as a complex intervention within a complex system and developed as a dynamic, evolving set of processes to support and motivate children towards healthy behaviours. The delivery methods used are highly interactive and encourage identification with and ownership of the healthy lifestyle messages so that the children are motivated to take them home to their parents and effect change within the family. We have good evidence that HeLP engages schools and children such that they want to participate in the Programme. Results from an exploratory trial showed that the Programme is feasible and acceptable and has the potential to change behaviours and affect weight status. This paper presents an overview of and recommendations arising from the conceptualization; development and evaluation of the Healthy Lifestyles Programme as part of a special issue focusing on novel approaches to the global problem of childhood obesity.
Kure-Biegel, Nanna; Schnohr, Christina Warrer; Hindhede, Anette Lykke
BACKGROUND: Individual-based interventions aim to improve patient self-management of chronic disease and to improve lifestyle among people at high risk, to reduce the prevalence of diseases contributing to health inequality. The present study investigates risk factors for uncompleted health...... interventions, via a combination of quantitative and qualitative methods. METHODS: From a health centre in Copenhagen, questionnaire data on educational level, gender, age, and cohabitation status from 104 participants in health interventions were used to examine risks for dropout. Qualitative telephone...... with low socioeconomic status will most likely have reduced opportunities for making healthy choices, in this case, completing the intervention, and this may increase health inequality....
Dover, Robert V H; Lambert, Estelle V
Using the nexus between food consumption, food security and obesity, this paper addresses the complexity of health behavior decision-making moments that reflect relational social dynamics in context-specific dialogues, often in choice-constrained conditions. A pragmatic review of literature regarding social determinants of health in relation to food consumption, food security and obesity was used to advance this theoretical model. We suggest that health choice, such as food consumption, is based on more than the capacity and volition of individuals to make "healthy" choices, but is dialogic and adaptive. In terms of food consumption, there will always be choice-constrained conditions, along a continuum representing factors over which the individual has little or no control, to those for which they have greater agency. These range from food store geographies and inventories and food availability, logistical considerations such as transportation, food distribution, the structure of equity in food systems, state and non-government food and nutrition programs, to factors where the individual exercises a greater degree of autonomy, such as sociocultural foodways, family and neighborhood shopping strategies, and personal and family food preferences. At any given food decision-making moment, many factors of the continuum are present consciously or unconsciously when the individual makes a decision. These health behavior decision-making moments are mutable, whether from an individual perspective, or within a broader social or policy context. We review the construct of "choice set", the confluence of factors that are temporally weighted by the differentiated and relationally-contextualized importance of certain factors over others in that moment. The choice transition represents an essential shift of the choice set based on the conscious and unconscious weighting of accumulated evidence, such that people can project certain outcomes. Policies and interventions should avoid
Paul, Ian M; Williams, Jennifer S; Anzman-Frasca, Stephanie; Beiler, Jessica S; Makova, Kateryna D; Marini, Michele E; Hess, Lindsey B; Rzucidlo, Susan E; Verdiglione, Nicole; Mindell, Jodi A; Birch, Leann L
Because early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This "parenting" intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT's central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent-child responsibility for feeding, reducing subsequent risk for overeating and overweight. 316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the "parenting" or "safety" groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3-4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic predictors of weight status. Finally, second
Darviri, Christina; Alexopoulos, Evangelos C; Artemiadis, Artemios K; Tigani, Xanthi; Kraniotou, Christina; Darvyri, Panagiota; Chrousos, George P
The main goal of stress management and health promotion programs is to improve health by empowering people to take control over their lives. Daily health-related lifestyle choices are integral targets of these interventions and critical to evaluating their efficacy. To date, concepts such as self-efficacy, self-control and empowerment are assessed by tools that only partially address daily lifestyle choices. The aim of this study is to validate a novel measurement tool, the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ), which aims to assess the concept of empowerment through a constellation of daily activities. Therefore, we performed principal component analysis (PCA) of 26 items that were derived from the qualitative data of several stress management programs conducted by our research team. The PCA resulted in the following five-factor solution: 1) Dietary Healthy Choices, 2) Dietary Harm Avoidance, 3) Daily Routine, 4) Organized Physical Exercise and 5) Social and Mental Balance. All subscales showed satisfactory internal consistency and variance, relative to theoretical score ranges. Subscale scores and the total score were significantly correlated with perceived stress and health locus of control, implying good criterion validity. Associations with sociodemographic data and other variables, such as sleep quality and health assessments, were also found. The HLPCQ is a good tool for assessing the efficacy of future health-promoting interventions to improve individuals' lifestyle and wellbeing.
Grech, A; Allman-Farinelli, M
Internationally, vending machines are scrutinized for selling energy-dense nutrient-poor foods and beverages, and the contribution to overconsumption and subsequent risk of obesity. The aim of this review is to determine the efficacy of nutrition interventions in vending machine in eliciting behaviour change to improve diet quality or weight status of consumers. Electronic databases Cochrane, EMBASE, CINAHL, Science Direct and PubMed were searched from inception. (i) populations that have access to vending machines; (ii) nutrition interventions; (iii) measured outcomes of behaviour change (e.g. sales data, dietary intake or weight change); and (iv) experimental trials where controls were not exposed to the intervention. Risk of bias was assessed independently by two researchers, and higher quality research formed the basis of this qualitative review. Twelve articles from 136 searched were included for synthesis. Intervention settings included schools, universities and workplaces. Reducing price or increasing the availability increased sales of healthier choices. The results of point-of-purchase nutrition information interventions were heterogeneous and when measured changes to purchases were small. This review offers evidence that pricing and availability strategies are effective at improving the nutritional quality foods and beverages purchased from vending machines. Evidence on how these interventions alter consumer's overall diet or body mass index is needed. © 2015 World Obesity.
Papies, E.K.; Veling, H.P.
There is a growing consensus that our food-rich living environment contributes to rising numbers of people with overweight and obesity. Low-cost, effective intervention tools are needed to facilitate healthy eating behavior, especially when eating away from home. Therefore, we present a field
Macoveanu, Julian; Fisher, Patrick M; Haahr, Mette E
the involvement of the normally functioning 5HT-system in decision-making under risk and processing of monetary rewards. The data suggest that prolonged SSRI treatment might reduce emotional engagement by reducing the impact of risk during decision-making or the impact of reward during outcome evaluation....... to placebo, the SSRI intervention did not alter individual risk-choice preferences, but modified neural activity during decision-making and reward processing: During the choice phase, SSRI reduced the neural response to increasing risk in lateral orbitofrontal cortex, a key structure for value-based decision-making...... functional MRI (fMRI) to investigate how a three-week fluoxetine intervention influences neural activity related to risk taking and reward processing. Employing a double-blinded parallel-group design, 29 healthy young males were randomly assigned to receive 3 weeks of a daily dose of 40 mg fluoxetine...
Roberto, Christina A; Bragg, Marie A; Livingston, Kara A; Harris, Jennifer L; Thompson, Jackie M; Seamans, Marissa J; Brownell, Kelly D
The 'Smart Choices' programme was an industry-driven, front-of-package (FOP) nutritional labelling system introduced in the USA in August 2009, ostensibly to help consumers select healthier options during food shopping. Its nutritional criteria were developed by members of the food industry in collaboration with nutrition and public health experts and government officials. The aim of the present study was to test the extent to which products labelled as 'Smart Choices' could be classified as healthy choices on the basis of the Nutrient Profile Model (NPM), a non-industry-developed, validated nutritional standard. A total of 100 packaged products that qualified for a 'Smart Choices' designation were sampled from eight food and beverage categories. All products were evaluated using the NPM method. In all, 64 % of the products deemed 'Smart Choices' did not meet the NPM standard for a healthy product. Within each 'Smart Choices' category, 0 % of condiments, 8·70 % of fats and oils, 15·63 % of cereals and 31·58 % of snacks and sweets met NPM thresholds. All sampled soups, beverages, desserts and grains deemed 'Smart Choices' were considered healthy according to the NPM standard. The 'Smart Choices' programme is an example of industries' attempts at self-regulation. More than 60 % of foods that received the 'Smart Choices' label did not meet standard nutritional criteria for a 'healthy' food choice, suggesting that industries' involvement in designing labelling systems should be scrutinized. The NPM system may be a good option as the basis for establishing FOP labelling criteria, although more comparisons with other systems are needed.
Kolahdooz, Fariba; Pakseresht, Mohammadreza; Mead, Erin; Beck, Lindsay; Corriveau, André; Sharma, Sangita
The 12-month Healthy Foods North intervention program was developed to improve diet among Inuit and Inuvialuit living in Arctic Canada and assess the impact of the intervention established for the communities. A quasi-experimental study randomly selected men and women (≥19 years of age) in six remote communities in Nunavut and the Northwest Territories. Validated quantitative food frequency and adult impact questionnaires were used. Four communities received the intervention and two communities served as delayed intervention controls. Pre- and post-intervention changes in frequency of/total intake of de-promoted food groups and healthiness of cooking methods were determined. The impact of the intervention was assessed using analysis of covariance (ANCOVA). Post-intervention data were analysed in the intervention (n = 221) and control (n = 111) communities, with participant retention rates of 91% for Nunavut and 83% for the Northwest Territories. There was a significant decrease in de-promoted foods, such as high fat meats (-27.9 g) and high fat dairy products (-19.8 g) among intervention communities (all p ≤ 0.05). The use of healthier preparation methods significantly increased (14.7%) in intervention communities relative to control communities. This study highlights the importance of using a community-based, multi-institutional nutrition intervention program to decrease the consumption of unhealthy foods and the use of unhealthy food preparation methods.
de Ridder, Denise; Kroese, Floor; Evers, Catharine; Adriaanse, Marieke; Gillebaart, Marleen
Objective: To discuss healthy diet from a psychological perspective by considering definitions of healthy diet in terms of consumer understanding; the health effects of specific dietary elements in terms of overweight and (chronic) illness; the prevalence of healthy diet; the psychological and
Leme, Ana Carolina Barco; Philippi, Sonia Tucunduva; Thompson, Debbe; Nicklas, Theresa; Baranowski, Tom
To evaluate the immediate post-intervention and 6-month post-intervention effects of a Brazilian school-based randomized controlled trial for girls targeting shared risk factors for obesity and disordered eating. Total of 253 girls, mean of 15.6 (0.05) years from 1st to 3rd grades of high school participated in this 6-month school-based cluster randomized controlled trial. "Healthy Habits, Healthy Girls-Brazil (H3G-Brazil)", originally developed in Australia, emphasized 10 key nutrition and physical activity (PA) messages delivered over 6 months. Disordered eating prevention procedures, i.e., prevention of weight-teasing, body satisfaction, and unhealthy weight control behavior, were added to the intervention. Body dissatisfaction, unhealthy weight control behaviors and social cognitive-related diet, and physical activity variables were assessed at baseline, immediate post-intervention, and 6-month post-intervention. Intervention effects were determined by one-way analysis of covariance or logistic regression, after checking for the clustering effects of school. The control group did not receive intervention prior to follow-up assessment. A conservative significance level was set at p healthy eating strategies (F = 6.08, p = 0.01) immediate post-intervention; and healthy eating social support (F = 14.731, p = 0.00) and healthy eating strategies (F = 5.812, p = 0.01) at 6-month post-intervention. Intervention group was more likely to report unhealthy weight control behaviors (OR = 1.92, 95% CI 1.15-3.21, p = 0.01) at 6-month post-intervention. No other significant immediate or 6-month post effects were detected. H3G-Brazil demonstrated positive 6-month effects on some social cognitive variables but an adverse effect on unhealthy weight control behaviors. Thus, this study was not able to achieve synergy by combining obesity and disordered eating prevention procedures in an intervention among low-income girls in Brazil. Level I
Every person has a stake in environmental public health. As the environment deteriorates, so does the physical and mental health of the people within it. Healthy places are those designed and built to improve the quality of life for all people who live, work, worship, learn, and play within their borders -- where every person is free to make choices amid a variety of healthy, available, accessible, and affordable options. The CDC recognizes significant health issues and places that are vital in developing the Healthy Places program and provides examples in this report. Created: 4/10/2007 by CDC National Center for Environmental Health. Date Released: 4/13/2007.
Gittelsohn, Joel; Dyckman, William; Frick, Kevin D; Boggs, Malia K; Haberle, Heather; Alfred, Julia; Vastine, Amy; Palafox, Neal
To improve diet and reduce risk for obesity and chronic disease, we developed, implemented and evaluated a pilot intervention trial with 23 large and small food stores in the Republic of the Marshall Islands (12 intervention, 11 control). The intervention included both mass media (radio announcements, newspaper ads, video) and in-store (cooking demonstrations, taste tests, shelf labeling) components. Consumer exposure to the mass media components was high (65% had heard half or more of the radio announcements, 74% had seen at least one of the newspaper ads). Consumer exposure to the in-store components of the intervention was moderate (61% attended at least one cooking demonstrations, 59% received at least one recipe card). After adjustment for age, sex and education level, increased exposure to the intervention was associated with higher diabetes knowledge (p<0.05) and label reading knowledge (p<0.05), but not with increased self-efficacy for performing promoted healthy behaviors. The intervention was associated with increased purchasing of certain promoted foods (p<0.005), including oatmeal, turkey chili, fish, canned fruit and local vegetables. It was also associated with improvements in healthiness of cooking methods (p<0.05). Food store centered interventions have great potential for changing cognitive and behavioral factors relating to food choice and preparation, and may contribute to lessening the burden of diet-related chronic disease worldwide.
Moreno-Maldonado, Concepción; Ramos, Pilar; Moreno, Carmen; Rivera, Francisco
Psychologists in schools can play an important role in developing policies and programs to promote healthy eating habits. This study analyses the contributions of family socioeconomic status, peer influence (schoolmates' food consumption), and school-based nutrition interventions to explain adolescent eating behaviors. Data were obtained from the…
Helland, Sissel H; Bere, Elling; Øverby, Nina Cecilie
There is concern about the lack of diversity in children's diets, particularly low intakes of fruit and vegetables and high intakes of unhealthy processed food. This may be a factor in the rising prevalence of obesity. A reason for the lack of diversity in children's diets may be food neophobia. This study aimed to promote a healthy and varied diet among toddlers in kindergarten. The primary objectives were to reduce food neophobia in toddlers, and promote healthy feeding practices among kindergarten staff and parents. Secondary objectives were to increase food variety in toddlers' diets and reduce future overweight and obesity in these children. This is an ongoing, cluster randomized trial. The intervention finished in 2014, but follow-up data collection is not yet complete. Eighteen randomly selected kindergartens located in two counties in Norway with enrolled children born in 2012 participated in the intervention. The kindergartens were matched into pairs based on background information, and randomly assigned to the intervention or control groups. A 9-week multi-component intervention was implemented, with four main elements: 1) kindergarten staff implemented a pedagogical tool (Sapere method) in daily sessions to promote willingness to try new food; 2) kindergarten staff prepared and served the toddlers a cooked lunch from a menu corresponding to the pedagogical sessions; 3) kindergarten staff were encouraged to follow 10 meal principles on modeling, responsive feeding, repeated exposure, and enjoyable meals; and 4) parents were encouraged to read information and apply relevant feeding practices at home. The control group continued their usual practices. Preference taste tests were conducted to evaluate behavioral food neophobia, and children's height and weight were measured. Parents and staff completed questionnaires before and after the intervention. Data have not yet been analyzed. This study provides new knowledge about whether or not a Sapere
Mobley, Connie C; Stadler, Diane D; Staten, Myrlene A; El Ghormli, Laure; Gillis, Bonnie; Hartstein, Jill; Siega-Riz, Anna Maria; Virus, Amy
The HEALTHY primary prevention trial developed an integrated multicomponent intervention program to moderate risk factors for type 2 diabetes in middle schools. The nutrition component aimed to improve the quality of foods and beverages served to students. Changes in the School Breakfast Program (SBP), National School Lunch Program (NSLP), and à la carte venues are compared to the experience of control schools. The intervention was implemented in 21 middle schools from winter 2007 through spring 2009 (following a cohort of students from sixth through eighth grades); 21 schools acted as observed controls. The nutrition component targeted school food service environmental change. Data identifying foods and nutrients served (selected by students for consumption) were collected over a 20-day period at baseline and end of study. Analysis compared end of study values for intervention versus control schools. Intervention schools more successfully limited dessert and snack food portion size in NSLP and à la carte and lowered fat content of foods served. Servings of high-fiber grain-based foods and/or legumes were improved in SBP but not NSLP. Intervention and control schools eliminated >1% fat milk and added-sugar beverages in SBP, but intervention schools were more successful in NSLP and à la carte. The HEALTHY program demonstrated significant changes in the nutritional quality of foods and beverages served in the SBP, NSLP, and à la carte venues, as part of an effort to decrease childhood obesity and support beneficial effects in some secondary HEALTHY study outcomes. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.
Misawa, Akemi; Yoshita, Katsushi; Fukumura, Tomoe; Tanaka, Taichiro; Tamaki, Junko; Takebayashi, Toru; Kusaka, Yukinori; Nakagawa, Hideaki; Yamato, Hiroshi; Okayama, Akira; Miura, Katsuyuki; Okamura, Tomonori; Ueshima, Hirotsugu
We examined the effects on employee vegetable intake of a long-term intervention in an employee work cafeteria. The subjects were approximately 1,200 employees (aged 19-61 years) of an industrial company in Fukui prefecture. We promoted the intake of typical Japanese style meals that combined three elements (staple foods, main dishes and vegetable dishes) to increase vegetables intake. We displayed all items on the menus of the employee cafeteria using three colors (yellow, red and green to denote three elements) to indicate healthy food choices for the maintenance of a healthy food environment. We advised employees to choose meals containing the three elements at the time of payment, for nutritional education (appropriate portion choice: APC). We evaluated the ratio of APC at the same time. To calculate the mean daily intake per person, we carried out a questionnaire survey similar to the "semi-quantitative food frequency questionnaire" and asked about the frequency and approximate intake of vegetables. The APC was 63.5% after one year of intervention, significantly increased to 82.1% after two years (p breakfast (p < 0.001), lunch (p < 0.001) and dinner (p = 0.011), and from vegetable juice (p = 0.030) significantly increased after three years of intervention. The consumption of pickles significantly decreased after three years of intervention (p = 0.009). It was estimated that the vegetable intake of men increased from 167.3 to 184.6 g, and that of women from 157.9 to 187.7 g. Employee estimated vegetable intake was significantly increased and that of pickles was significantly decreased by a long-term intervention (three years) in the employee work cafeteria.
Full Text Available Eating location has been linked with variations in diet quality including the consumption of low-nutrient energy-dense food, which is a recognised risk factor for obesity. Cross-sectional data from 4736 adults aged 19 years and over from Years 1–6 of the UK National Diet and Nutrition Survey (NDNS Rolling Programme (RP (2008–2014 were used to explore food consumption patterns by eating location. Eating location was categorized as home, work, leisure places, food outlets and “on the go”. Foods were classified into two groups: core (included in the principal food groups and considered important/acceptable within a healthy diet and non-core (all other foods. Out of 97,748 eating occasions reported, the most common was home (67–90% of eating occasions. Leisure places, food outlets and “on the go” combined contributed more energy from non-core (30% than from core food (18%. Analyses of modulating factors revealed that sex, income, frequency of eating out and frequency of drinking were significant factors affecting consumption patterns (p < 0.01. Our study provides evidence that eating patterns, behaviours and resulting diet quality vary by location. Public health interventions should focus on availability and access to healthy foods, promotion of healthy food choices and behaviours across multiple locations, environments and contexts for food consumption.
Full Text Available Abstract Background The adoption of a healthy lifestyle, including physical activity, a balanced diet, a moderate alcohol consumption and abstinence from smoking, are associated with large decreases in the incidence and mortality rates for the most common chronic diseases. That is why primary health care (PHC services are trying, so far with less success than desirable, to promote healthy lifestyles among patients. The objective of this study is to design and model, under a participative collaboration framework between clinicians and researchers, interventions that are feasible and sustainable for the promotion of healthy lifestyles in PHC. Methods and design Phase I formative research and a quasi-experimental evaluation of the modelling and planning process will be undertaken in eight primary care centres (PCCs of the Basque Health Service – OSAKIDETZA, of which four centres will be assigned for convenience to the Intervention Group (the others being Controls. Twelve structured study, discussion and consensus sessions supported by reviews of the literature and relevant documents, will be undertaken throughout 12 months. The first four sessions, including a descriptive strategic needs assessment, will lead to the prioritisation of a health promotion aim in each centre. In the remaining eight sessions, collaborative design of intervention strategies, on the basis of a planning process and pilot trials, will be carried out. The impact of the formative process on the practice of healthy lifestyle promotion, attitude towards health promotion and other factors associated with the optimisation of preventive clinical practice will be assessed, through pre- and post-programme evaluations and comparisons of the indicators measured in professionals from the centres assigned to the Intervention or Control Groups. Discussion There are four necessary factors for the outcome to be successful and result in important changes: (1 the commitment of professional
Halimic, Aida; Gage, Heather; Raats, Monique; Williams, Peter
To explore the impact of price manipulation and healthy eating information on intended food choices. Health information was provided to a random half of subjects (vs. information on Saudi agriculture). Each subject chose from the same lunch menu, containing two healthy and two unhealthy entrees, deserts and beverages, on five occasions. Reference case prices were 5, 3 and 2 Saudi Arabian Reals (SARs). Prices of healthy and unhealthy items were manipulated up (taxed) and down (subsidized) by 1 SAR in four menu variations (random order); subjects were given a budget enabling full choice within any menu. The number of healthy food choices were compared with different price combinations, and between information groups. Linear regression modelling explored the effect of relative prices of healthy/unhealthy options and information on number of healthy choices controlling for dietary behaviours and hunger levels. University campus, Saudi Arabia, 2013. 99 women students. In the reference case, 49.5% of choices were for healthy items. When the price of healthy items was reduced, 58.5% of selections were healthy; 57.2% when the price of unhealthy items rose. In regression modelling, reducing the price of healthy items and increasing the price of unhealthy items increased the number of healthy choices by 5% and 6% respectively. Students reporting a less healthy usual diet selected significantly fewer healthy items. Providing healthy eating information was not a significant influence. Price manipulation offers potential for altering behaviours to combat rising youth obesity in Saudi Arabia. Copyright © 2018 Elsevier Ltd. All rights reserved.
So, Daniel; Whelan, Kevin; Rossi, Megan; Morrison, Mark; Holtmann, Gerald; Kelly, Jaimon T; Shanahan, Erin R; Staudacher, Heidi M; Campbell, Katrina L
Dysfunction of the gut microbiota is frequently reported as a manifestation of chronic diseases, and therefore presents as a modifiable risk factor in their development. Diet is a major regulator of the gut microbiota, and certain types of dietary fiber may modify bacterial numbers and metabolism, including short-chain fatty acid (SCFA) generation. A systematic review and meta-analysis were undertaken to assess the effect of dietary fiber interventions on gut microbiota composition in healthy adults. A systematic search was conducted across MEDLINE, EMBASE, CENTRAL, and CINAHL for randomized controlled trials using culture and/or molecular microbiological techniques evaluating the effect of fiber intervention on gut microbiota composition in healthy adults. Meta-analyses via a random-effects model were performed on alpha diversity, prespecified bacterial abundances including Bifidobacterium and Lactobacillus spp., and fecal SCFA concentrations comparing dietary fiber interventions with placebo/low-fiber comparators. A total of 64 studies involving 2099 participants were included. Dietary fiber intervention resulted in higher abundance of Bifidobacterium spp. (standardized mean difference (SMD): 0.64; 95% CI: 0.42, 0.86; P < 0.00001) and Lactobacillus spp. (SMD: 0.22; 0.03, 0.41; P = 0.02) as well as fecal butyrate concentration (SMD: 0.24; 0.00, 0.47; P = 0.05) compared with placebo/low-fiber comparators. Subgroup analysis revealed that fructans and galacto-oligosaccharides led to significantly greater abundance of both Bifidobacterium spp. and Lactobacillus spp. compared with comparators (P < 0.00001 and P = 0.002, respectively). No differences in effect were found between fiber intervention and comparators for α-diversity, abundances of other prespecified bacteria, or other SCFA concentrations. Dietary fiber intervention, particularly involving fructans and galacto-oligosaccharides, leads to higher fecal abundance of Bifidobacterium and Lactobacillus
Nebot Paradells, Vicente; Pablos Monzó, Ana; Elvira Macagno, Laura; Guzmán Luján, José Francisco; Pablos Abella, Carlos
it is vital to monitor and promote healthy lifestyle habits in early adolescence, as it is a time of changes when future lifestyle habits are formed. a study was conducted to find out the effects of a Healthy Habits Program (HHP) in children between the ages of 10 and 12 years (N = 158). The study included an intervention group (IG) (n = 90), which participated in the HHP for 8 months, and a control group (CG) (n = 100). In order to assess healthy habits in these children we used the Inventory of Healthy Habits (IHH), the reliability of which was previously evaluated (N = 134). the IHH obtained good reliability, Interclass Correlation Coefficient (range .506 - 884; p eating habits initially (p = .564), but by the end of the study (p = .001) the IG showed better habits. As for the other healthy habits indicators, the CG had better habits initially (p = .047), but the score of the IG improved and there were no differences between the groups at the end of the study. it was shown that the IHH is a suitable and reliable questionnaire for studying habits in adolescents. The HHP brought about changes in the IG, which achieved better scores for eating habits and sum of health habits. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Waters, Elizabeth; Gibbs, Lisa; Tadic, Maryanne; Ukoumunne, Obioha C; Magarey, Anthea; Okely, Anthony D; de Silva, Andrea; Armit, Christine; Green, Julie; O'Connor, Thea; Johnson, Britt; Swinburn, Boyd; Carpenter, Lauren; Moore, Graham; Littlecott, Hannah; Gold, Lisa
Multi-level, longer-term obesity prevention interventions that focus on inequalities are scarce. Fun 'n healthy in Moreland! aimed to improve child adiposity, school policies and environments, parent engagement, health behaviours and child wellbeing. All children from primary schools in an inner urban, culturally diverse and economically disadvantaged area in Victoria, Australia were eligible for participation. The intervention, fun 'n healthy in Moreland!, used a Health Promoting Schools Framework and provided schools with evidence, school research data and part time support from a Community Development Worker to develop health promoting strategies. Comparison schools continued as normal. Participants were not blinded to intervention status. The primary outcome was change in adiposity. Repeated cross-sectional design with nested longitudinal subsample. Students from twenty-four primary schools (clusters) were randomised (aged 5-12 years at baseline). 1426 students from 12 intervention schools and 1539 students from 10 comparison schools consented to follow up measurements. Despite increased prevalence of healthy weight across all schools, after 3.5 years of intervention there was no statistically significant difference between trial arms in BMI z score post-intervention (Mean (sd): Intervention 0.68(1.16); Comparison: 0.72(1.12); Adjusted mean difference (AMD): -0.05, CI: -0.19 to 0.08, p = 0.44). Children from intervention schools consumed more daily fruit serves (AMD: 0.19, CI:0.00 to 0.37, p = 0.10), were more likely to have water (AOR: 1.71, CI:1.05 to 2.78, p = 0.03) and vegetables (AOR: 1.23, CI: 0.99 to 1.55, p = 0.07), and less likely to have fruit juice/cordial (AOR: 0.58, CI:0.36 to 0.93, p = 0.02) in school lunch compared to children in comparison schools. More intervention schools (8/11) had healthy eating and physical activity policies compared with comparison schools (2/9). Principals and schools highly valued the approach as a catalyst
Shaping children's healthy eating habits with food placements? Food placements of high and low nutritional value in cartoons, Children's BMI, food-related parental mediation strategies, and food choice
Naderer, B.; Matthes, J.; Binder, A.; Marquart, F.; Mayrhofer, M.; Obereder, A.; Spielvogel, I.
Research on media induced food choices of children has not sufficiently investigated whether food placements of snacks high in nutritional value can strengthen children's healthy eating behavior. Furthermore, we lack knowledge about the moderating role of children's individual characteristics such
Furia, Andrea C; Lee, Rebecca E; Strother, Myra L; Huang, Terry T-K
To develop and refine a scale of motivational factors related to healthy weight achievement and maintenance and to examine differences by gender and weight status. A cross-sectional survey of 300 university students aged 18-24 years. Factor analysis yielded 6 factors-Intrinsic (Cronbach's alpha=0.73): affective motivation, self-efficacy/interest; Extrinsic (Cronbach's alpha=0.68): social reward, peer pressure, lack of choice, and authority influence. Males and normal-weight students showed higher affective motivation and overall intrinsic motivation compared to females and overweight students, (PIntrinsic motivational factors and gender differences should be considered in developing obesity prevention interventions in this age-group.
Harms, Job; Rosenkranz, S.; Sanders, M.W.J.L.
In this study we investigate how two types of information interventions, providing a benchmark and providing costly information on option ranking, can improve decision-making in complex choices. In our experiment subjects made a series of incentivized choices between four hypothetical financial
Thorsen, Anne Vibeke
The challenge of public health nutrition in relation to worksite settings is to improve access to healthier meal options – especially for the groups with a lower educational level. Strategies changing the dietary environment such as increasing the availability of healthy food and reducing barriers...... by the involved local actors' ideas of health and nutrition and also by their concepts of how these ideas interrelate with the worksite’s working conditions and working performance. A combination of a social shaping approach and a worksite policy process approach to the shaping and embedding of healthy worksite...... a crucial role. The results of this thesis point to the need for a more widespread implementation of strategies that promote healthier eating at worksite canteens. The results indicate that a worksite intervention needs to be tailored to the needs of the particular worksite environment in which...
Macoveanu, Julian; Fisher, Patrick M; Madsen, Martin K
Bright-light interventions have successfully been used to reduce depression symptoms in patients with seasonal affective disorder, a depressive disorder most frequently occurring during seasons with reduced daylight availability. Yet, little is known about how light exposure impacts human brain...... function, for instance on risk taking, a process affected in depressive disorders. Here we examined the modulatory effects of bright-light exposure on brain activity during a risk-taking task. Thirty-two healthy male volunteers living in the greater Copenhagen area received 3weeks of bright......-light intervention during the winter season. Adopting a double-blinded dose-response design, bright-light was applied for 30minutes continuously every morning. The individual dose varied between 100 and 11.000lx. Whole-brain functional MRI was performed before and after bright-light intervention to probe how...
Karen E Peterson
Full Text Available Few dissemination evaluations exist to document the effectiveness of evidence-based childhood obesity interventions outside the research setting.Evaluate Healthy Choices (HC, a multi-component obesity prevention program, by examining school-level changes in weight-related behaviors and weight status and the association of implementation components with odds of overweight/obesity.We compared baseline and Year 3 school-level behavioral and weight status outcomes with paired t-tests adjusted for schools' socio-demographic characteristics. We used generalized estimating equations to examine the odds of overweight/obesity associated with program components.Consecutive sample of 45 of 51 middle schools participating in the HC program with complete baseline and follow-up survey data including a subsample of 35 schools with measured anthropomentry for 5,665 7th grade students.Schools developed a multi-disciplinary team and implemented an obesity prevention curriculum, before and after school activities, environmental and policy changes and health promotions targeting a 5-2-1 theme: eat ≥ 5 servings/day of fruits and vegetables (FV, watch ≤ 2 hours of television (TV and participate in ≥ 1 hours/day of physical activity (PA on most days.1 School-level percent of students achieving targeted behaviors and percent overweight/obese; and 2 individual odds of overweight/obesity.The percent achieving behavioral goals over three years increased significantly for FV: 16.4 to 19.4 (p = 0.001, TV: 53.4 to 58.2 (p = 0.003 and PA: 37.1 to 39.9 (p = 0.02, adjusting for school size, baseline mean age and percent female, non-Hispanic White, and eligible for free and reduced price lunch. In 35 schools with anthropometry, the percent of overweight/obese 7th grade students decreased from 42.1 to 38.4 (p = 0.016. Having a team that met the HC definition was associated with lower odds of overweight/obesity (OR = 0.83, CI: 0.71-0.98.The HC multi-component intervention
Sheppes, Gal; Scheibe, Susanne; Suri, Gaurav; Radu, Peter; Blechert, Jens; Gross, James J.
Choice behavior is considered the fundamental means by which individuals exert control over their environments. One important choice domain that remains virtually unexplored is that of emotion regulation. This is surprising given that healthy adaptation requires flexibly choosing between regulation
Hunter, Ruth F; Christian, Hayley; Veitch, Jenny
positive effect) to support built environment only interventions for encouraging use and increasing PA in urban green space. There was more promising evidence (3/3 studies showed positive effect) to support PAprograms or PA programs combined with a physical change to the built environment, for increasing...... in this area. Interventions that involve the use of PA programs combined with a physical change to the built environment are likely to have a positive effect on PA. Robust evaluations of such interventions are urgently required. The findings provide a platform to inform the design, implementation......Evidence is mounting on the association between the built environment and physical activity (PA) with a call for intervention research. A broader approach which recognizes the role of supportive environments that can make healthy choices easier is required. A systematic review was undertaken...
Gardner, Jolynn; Kjolhaug, Jerri; Linde, Jennifer A; Sevcik, Sarah; Lytle, Leslie A
This article describes the effectiveness of goal setting instruction in the CHOICES (Choosing Healthy Options in College Environments and Settings) study, an intervention evaluating the effectiveness of weight gain prevention strategies for 2-year college students. Four hundred and forty-one participants from three community colleges were recruited. Participants randomized into the intervention (n=224) enrolled in a course that taught strategies to help maintain or achieve a healthy weight. Participants were instructed in SMART (Specific, Measurable, Attainable, Realistic, Time-based) and behavioral goal-setting practices. Throughout the course, participants set goals related to improving their sleep, stress-management, exercise, and nutrition." Intervention participants set four hundred eighteen goals. Each goal was carefully evaluated. The efforts to teach behavioral goal-setting strategies were largely successful; however efforts to convey the intricacies of SMART goal-setting were not as successful. Implications for effective teaching of skills in setting SMART behavioral goals were realized in this study. The insights gained from the goal-setting activities of this study could be used to guide educators who utilize goals to achieve health behavior change. Based on the results of this study, it is recommended that very clear and directed instruction be provided in addition to multiple opportunities for goal-setting practice. Implications for future interventions involving education about goal-setting activities are discussed.
Pechey, Rachel; Monsivais, Pablo
Both SES and supermarket choice have been associated with diet quality. This study aimed to assess the contributions of supermarket choice and shopping behaviors to the healthfulness of purchases and social patterning in purchases. Observational panel data on purchases of fruit and vegetables and less-healthy foods/beverages from 2010 were obtained for 24,879 households, stratified by occupational social class (analyzed in 2014). Households' supermarket choice was determined by whether they ever visited market-defined high- or low-price supermarkets. Analyses also explored extent of use within supermarket choice groups. Shopping behaviors included trip frequency, trip size, and number of store chains visited. Households using low-price (and not high-price) supermarkets purchased significantly lower percentages of energy from fruit and vegetables and higher percentages of energy from less-healthy foods/beverages than households using high-price (and not low-price) supermarkets. When controlling for SES and shopping behaviors, the effect of supermarket choice was reduced but remained significant for both fruit and vegetables and less-healthy foods/beverages. The extent of use of low- or high-price supermarkets had limited effects on outcomes. More-frequent trips and fewer small trips were associated with healthier purchasing for both outcomes; visiting more store chains was associated with higher percentages of energy from fruit and vegetables. Although both supermarket choice and shopping behaviors are associated with healthfulness of purchases, neither appears to contribute to socioeconomic differences. Moreover, differences between supermarket environments may not be primary drivers of the relationship between supermarket choice and healthfulness of purchases. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Full Text Available BACKGROUND: The purpose of this study is to evaluate the possible difference of the impact of Women Healthy Heart Project on lifestyle, as well as physical/biochemical parameters of working women and housewives. METHODS: This was a community-based intervention study conducted over 5 years (2002-2007 in the counties of Isfahan and Najafabad (intervention areas and Arak (control. Pre-study situation analysis of women was followed by 5 years of wide-ranging interventions (educational/environmental conducted by various organizations using different methodologies. The interventions were aimed at modifying/improving lifestyle by increasing physical activity, encouraging healthy eating, and tobacco use cessation. The organizations involved in performing the interventions included the local radio and television authority, health/treatment centers, the Red Crescent Society, Municipalities, the Relief Committee, the Center for Retirees’ Welfare, and the Literacy Campaign Organization. After 5 years, final phase same as first phase was planed. The subjects studied in all phases` the pre- and post-intervention phases consisted of 10586 women aged above 18 years. Demographic data, obesity index, smoking, physical activity and eating habit were assessed before and after the study. Data were analyzed using SPSS-15 using Student’s t-test, chi-square test, the general linear model of ANOVA, and logistic regression. RESULTS: We studied 10586 women (6105 and 4481 women, pre- and post-intervention, respectively. Mean age of working women was 34.14 ± 10.09 and 34.08 ± 9.35 years before and after the study, respectively. Mean age of housewives before and after the study was 40.05 ± 14.61 and 40.36 ± 15.32 years, respectively. Interventions conducted during 5 years improved eating habits and decreased tobacco use in working women and housewives. In every phase of the study, there was a significant age difference between housewives and working women
Bowling, April B; Moretti, Mikayla; Ringelheim, Kayla; Tran, Alvin; Davison, Kirsten
Healthy Foods, Healthy Families (HFHF) is a fruit and vegetable (F&V) exposure/incentive program implemented at farmers' markets in low-income neighborhoods, targeting families receiving US federal food assistance. We examined program effects on participants' diet and associations between attendance, demographics and dietary change. Exposure activities included F&V tastings and cooking demonstrations. Incentives included 40% F&V bonus for electronic benefit transfer (EBT) card users and $20 for use purchasing F&V at every third market visit. Self-report surveys measuring nutritional behaviors/literacy were administered to participants upon enrollment (n = 425, 46.2% Hispanic, 94.8%female). Participants were sampled for follow-up at markets during mid-season (n = 186) and at season end (n = 146). Attendance was tracked over 16 weeks. Participants post-intervention reported significantly higher vegetable consumption(P = 0.005) and lower soda consumption (P = 0.005). Participants reporting largest F&V increases attended the market 6-8 times and received $40 in incentives. No change in food assistance spent on F&V (P = 0.94); 70% reported significant increases in family consumption of F&V,indicating subsidies increased overall F&V purchasing. Participants reported exposure activities and incentives similarly affected program attendance. Interventions combining exposure activities and modest financial incentives at farmers' markets in low-income neighborhoods show strong potential to improve diet quality of families receiving federal food assistance.
Virudachalam, Senbagam; Chung, Paul J; Faerber, Jennifer A; Pian, Timothy M; Thomas, Karen; Feudtner, Chris
Though preparing healthy food at home is a critical health promotion habit, few interventions have aimed to improve parental cooking skills and behaviors. We sought to understand parents' preferences and priorities regarding interventions to improve home food preparation practices and home food environments during early childhood. We administered a discrete choice experiment using maximum difference scaling. Eighty English-speaking parents of healthy 1-4 year-old children rated the relative importance of potential attributes of interventions to improve home food preparation practices and home food environments. We performed latent class analysis to identify subgroups of parents with similar preferences and tested for differences between the subgroups. Participants were mostly white or black 21-45 year-old women whose prevalence of overweight/obesity mirrored the general population. Latent class analysis revealed three distinct groups of parental preferences for intervention content: a healthy cooking group, focused on nutrition and cooking healthier food; a child persuasion group, focused on convincing toddlers to eat home-cooked food; and a creative cooking group, focused on cooking without recipes, meal planning, and time-saving strategies. Younger, lower income, 1-parent households comprised the healthy cooking group, while older, higher income, 2-parent households comprised the creative cooking group (p cooked dinner regularly, unlike the other two groups (p food preparation practices. Such interventions are important for creating healthier home food environments and preventing obesity starting from early childhood. Copyright © 2015 Elsevier Ltd. All rights reserved.
Kähkönen, Outi; Kankkunen, Päivi; Saaranen, Terhi; Miettinen, Heikki; Kyngäs, Helvi; Lamidi, Marja-Leena
To test the Theory of Adherence of People with Chronic Disease with regard to adherence to treatment among patients with coronary heart disease after a percutaneous coronary intervention. Increased knowledge of the concept of adherence is needed for the development of nursing interventions and nursing guidelines for patients with coronary heart disease. A cross-sectional, multi-centre study. This study was conducted from February-December 2013 with 416 patients with coronary heart disease 4 months after undergoing a percutaneous coronary intervention. A self-reported questionnaire was used to assess their adherence to treatment. Data were analysed using structural equation modelling. The theory explained 45% of the adherence to a healthy lifestyle and 7% of the adherence to medication. Structural equation modelling confirmed that motivation and results of care had the highest association with adherence to a healthy lifestyle. Responsibility was associated with adherence to medication. Support from next of kin, support from nurses and physicians, and motivation, co-operation, fear of complications and a sense of normality were associated with adherence. Patients who are motivated to perform self-care and consider the results of care to be important were more likely to adhere to a healthy lifestyle. Responsible patients were more likely to adhere to their medication. It is important to account for these elements as a part of secondary prevention strategies among patients with coronary heart disease after a percutaneous coronary intervention. © 2015 John Wiley & Sons Ltd.
Iasiello, Matthew; Bartholomaeus, Jonathan; Jarden, Aaron; van Agteren, Joseph
Longevity is a valuable resource for society, as older people are increasingly looking for new ways to contribute after retirement. Their contribution is however dependent upon their physical health, mental health and wellbeing. The potential role that mental health and wellbeing, two separate but interrelated constructs, play often are both under-recognised and insufficiently targeted. Positive ageing is a positive and constructive view of ageing, where older people actively work on maintaining a positive attitude, work towards keeping fit and healthy, and strive to maximize their wellbeing. Interventions stimulating positive ageing show promising results for both mental health and wellbeing, and telehealth can play an important role in improving the reach and effectiveness of positive ageing interventions. Telehealth solutions can also help researchers reliably measure and better understand the drivers of wellbeing at individual and population levels; results that can both form the basis for advancing the field of positive ageing and help inform public policy.
Walsh, Audrey; Meagher-Stewart, Donna; Macdonald, Marilyn
Mothers' ability to provide healthy food choices for their children has become more complex in our current obesogenic environment. We conducted a total of 35 interviews with 18 mothers of preschool children. Using constructivist grounded theory methods, we developed a substantive theory of how mothers make food choices for their preschoolers. Our substantive theory, persistent optimizing, consists of three main integrated conceptual categories: (a) acknowledging contextual constraints, (b) stretching boundaries, and (c) strategic positioning. Implications to improve mothers' ability to make healthy food choices that reduce their children's risk of becoming overweight or obese are discussed. © The Author(s) 2014.
Wei, Jin; Hollin, Ilene; Kachnowski, Stan
We reviewed the literature on the use of text messaging for clinical and healthy behaviour interventions. Electronic databases were searched in December 2009 using keywords related to text messaging and health interventions. The final review included 24 articles. Of those, seven covered medication adherence, eight discussed clinical management and nine reported on health-related behaviour modification. Sixteen were randomized controlled trials (RCT), five were non-controlled pre-post comparison studies and three were feasibility pilots not reporting a behavioural outcome. The frequency of messaging ranged from multiple messages daily to one message per month. Among the 16 RCTs, 10 reported significant improvement with interventions and six reported differences suggesting positive trends. Text messaging received good acceptance and showed early efficacy in most studies. However, the evidence base is compromised by methodological limitations and is not yet conclusive.
Stensel David J
Full Text Available Abstract Background Physical inactivity is recognised as a public health concern within children and interventions to increase physical activity are needed. The purpose of this research was to evaluate the effect of a school-based healthy lifestyles intervention on physical activity, fruit and vegetable consumption, body composition, knowledge, and psychological variables. Method A non-randomised controlled study involving 8 primary schools (4 intervention, 4 control. Participants were 589 children aged 7–11 years. The intervention lasted 10 months and comprised a CD-rom learning and teaching resource for teachers; an interactive website for pupils, teachers and parents; two highlight physical activity events (1 mile school runs/walks; a local media campaign; and a summer activity wall planner and record. Primary outcome measures were objectively measured physical activity (pedometers and accelerometers and fruit and vegetable consumption. Secondary outcomes included body mass index, waist circumference, estimated percent body fat, knowledge, psychological variables. Multi-level modelling was employed for the data analysis. Results Relative to children in control schools, those in intervention schools significantly increased their total time in moderate-to-vigorous physical activity (MVPA (by 9 minutes/day vs a decrease of 10 minutes/day, their time in MVPA bouts lasting at least one minute (10 minutes/day increase vs no change and increased daily steps (3059 steps per day increase vs 1527 steps per day increase. A similar pattern of results was seen in a subset of the least active participants at baseline. Older participants in intervention schools showed a significant slowing in the rate of increase in estimated percent body fat, BMI, and waist circumference. There were no differences between groups in fruit and vegetable intake. Extrinsic motivation decreased more in the intervention group. Conclusion The intervention produced positive
Broers, Valérie J V; De Breucker, Céline; Van den Broucke, Stephan; Luminet, Olivier
Nudging refers to interventions that organize the choice architecture in order to alter people's behaviour in a predictable way without forbidding any options or significantly changing their economic incentives. As a strategy to encourage healthy behaviour, nudging can serve as a complement to health education. However, the empirical evidence regarding the effectiveness of nudging as a way to influence food choice remains contradictory. To address this issue, a systematic review and meta-analysis was conducted to test the effects of nudging to encourage people to select more fruit and vegetables. A systematic literature search was performed on PubMed, Medline, PsycInfo, Cochrane library, Scopus and Google Scholar. After quality assessment, 20 articles (23 studies) were retained for narrative synthesis. Twelve articles (14 studies) contained enough information to calculate effect-sizes for meta-analysis using Comprehensive Meta-analysis software. The meta-analysis shows that nudging interventions that aim to increase fruit and/or vegetable choice/sales/servings have a moderately significant effect (d = 0.30), with the largest effect for altering placement (d = 0.39) and combined nudges (d = 0.28). The results of this review provide an indication of the effectiveness of nudging on fruit and vegetable choice in terms of actual effect-sizes, while also highlighting the problems that must be addressed before more definitive conclusions can be drawn. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Sissel H. Helland
Full Text Available Abstract Background There is concern about the lack of diversity in children’s diets, particularly low intakes of fruit and vegetables and high intakes of unhealthy processed food. This may be a factor in the rising prevalence of obesity. A reason for the lack of diversity in children’s diets may be food neophobia. This study aimed to promote a healthy and varied diet among toddlers in kindergarten. The primary objectives were to reduce food neophobia in toddlers, and promote healthy feeding practices among kindergarten staff and parents. Secondary objectives were to increase food variety in toddlers’ diets and reduce future overweight and obesity in these children. Methods This is an ongoing, cluster randomized trial. The intervention finished in 2014, but follow-up data collection is not yet complete. Eighteen randomly selected kindergartens located in two counties in Norway with enrolled children born in 2012 participated in the intervention. The kindergartens were matched into pairs based on background information, and randomly assigned to the intervention or control groups. A 9-week multi-component intervention was implemented, with four main elements: 1 kindergarten staff implemented a pedagogical tool (Sapere method in daily sessions to promote willingness to try new food; 2 kindergarten staff prepared and served the toddlers a cooked lunch from a menu corresponding to the pedagogical sessions; 3 kindergarten staff were encouraged to follow 10 meal principles on modeling, responsive feeding, repeated exposure, and enjoyable meals; and 4 parents were encouraged to read information and apply relevant feeding practices at home. The control group continued their usual practices. Preference taste tests were conducted to evaluate behavioral food neophobia, and children’s height and weight were measured. Parents and staff completed questionnaires before and after the intervention. Data have not yet been analyzed. Discussion This study
Luten, Karla A; Reijneveld, Sijmen A; Dijkstra, Arie; de Winter, Andrea F
The aim of this study is to assess the reach and effectiveness of an integrated community-based intervention designed to promote physical activity and healthy eating among older adults in a socioeconomically disadvantaged community in the Netherlands. The intervention was evaluated with a controlled
Velema, Elizabeth; Vyth, Ellis L; Hoekstra, Trynke; Steenhuis, Ingrid H M
Currently, many studies focus on how the environment can be changed to encourage healthier eating behavior, referred to as choice architecture or "nudging." However, to date, these strategies are not often investigated in real-life settings, such as worksite cafeterias, or are only done so on a short-term basis. The objective of this study is to examine the effects of a healthy worksite cafeteria ["worksite cafeteria 2.0" (WC 2.0)] intervention on Dutch employees' purchase behavior over a 12-wk period. We conducted a randomized controlled trial in 30 worksite cafeterias. Worksite cafeterias were randomized to either the intervention or control group. The intervention aimed to encourage employees to make healthier food choices during their daily worksite cafeteria visits. The intervention consisted of 14 simultaneously executed strategies based on nudging and social marketing theories, involving product, price, placement, and promotion. Adjusted multilevel models showed significant positive effects of the intervention on purchases for 3 of the 7 studied product groups: healthier sandwiches, healthier cheese as a sandwich filling, and the inclusion of fruit. The increased sales of these healthier meal options were constant throughout the 12-wk intervention period. This study shows that the way worksite cafeterias offer products affects purchase behavior. Situated nudging and social marketing-based strategies are effective in promoting healthier choices and aim to remain effective over time. Some product groups only indicated an upward trend in purchases. Such an intervention could ultimately help prevent and reduce obesity in the Dutch working population. This trial was registered at the Dutch Trial Register (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5372) as NTR5372.
Carmona-Perera, Martina; Martí-García, Celia; Pérez-García, Miguel; Verdejo-García, Antonio
Moral decision-making is a key asset for humans' integration in social contexts, and the way we decide about moral issues seems to be strongly influenced by emotions. For example, individuals with deficits in emotional processing tend to deliver more utilitarian choices (accepting an emotionally aversive action in favor of communitarian well-being). However, little is known about the association between emotional experience and moral-related patterns of choice. We investigated whether subjective reactivity to emotional stimuli, in terms of valence, arousal, and dominance, is associated with moral decision-making in 95 healthy adults. They answered to a set of moral and non-moral dilemmas and assessed emotional experience in valence, arousal and dominance dimensions in response to neutral, pleasant, unpleasant non-moral, and unpleasant moral pictures. Results showed significant correlations between less unpleasantness to negative stimuli, more pleasantness to positive stimuli and higher proportion of utilitarian choices. We also found a positive association between higher arousal ratings to negative moral laden pictures and more utilitarian choices. Low dominance was associated with greater perceived difficulty over moral judgment. These behavioral results are in fitting with the proposed role of emotional experience in moral choice.
Carmona-Perera, Martina; Martí-García, Celia; Pérez-García, Miguel; Verdejo-García, Antonio
Moral decision-making is a key asset for humans’ integration in social contexts, and the way we decide about moral issues seems to be strongly influenced by emotions. For example, individuals with deficits in emotional processing tend to deliver more utilitarian choices (accepting an emotionally aversive action in favor of communitarian well-being). However, little is known about the association between emotional experience and moral-related patterns of choice. We investigated whether subjective reactivity to emotional stimuli, in terms of valence, arousal, and dominance, is associated with moral decision-making in 95 healthy adults. They answered to a set of moral and non-moral dilemmas and assessed emotional experience in valence, arousal and dominance dimensions in response to neutral, pleasant, unpleasant non-moral, and unpleasant moral pictures. Results showed significant correlations between less unpleasantness to negative stimuli, more pleasantness to positive stimuli and higher proportion of utilitarian choices. We also found a positive association between higher arousal ratings to negative moral laden pictures and more utilitarian choices. Low dominance was associated with greater perceived difficulty over moral judgment. These behavioral results are in fitting with the proposed role of emotional experience in moral choice. PMID:24133433
Goffe, Louis; Penn, Linda; Adams, Jean; Araujo-Soares, Vera; Summerbell, Carolyn D; Abraham, Charles; White, Martin; Adamson, Ashley; Lake, Amelia A
Much of the food available from takeaways, pubs and restaurants particularly that sold by independent outlets, is unhealthy and its consumption is increasing. These food outlets are therefore important potential targets for interventions to improve diet and thus prevent diet related chronic diseases. Local authorities in England have been charged with delivering interventions to increase the provision of healthy food choices in independent outlets, but prior research shows that few such interventions have been rigorously developed or evaluated. We aimed to learn from the experiences of professionals delivering interventions in independent food outlets in England to identify the operational challenges and their suggestions for best practice. We used one-to-one semi-structured qualitative interviews to explore the views and experiences of professionals who were either employees of, or contracted by, a local authority to deliver interventions to increase the provision of healthier food choices in independent food outlets. Purposive sampling was used to recruit a sample which included men and women, from a range of professional roles, across different areas of England. Interviews were informed by a topic guide, and proceeded until no new themes emerged. Interviews were recorded, transcribed verbatim and analysed using the Framework method. We conducted 11 individual interviews. Participants focussed on independent takeaways and their unhealthy food offerings, and highlighted the advantages and disadvantages of intervention delivery methods, their evaluation and impact. The main barriers to implementation of interventions in independent takeaways were identified as limited funding and the difficulties of engaging the food outlet owner/manager. Engagement was thought to be facilitated by delivering intensive, interactive and tailored interventions, clear and specific information, and incentives, whilst accounting for practical, primarily financial, constraints of food
Full Text Available Abstract Background Childhood obesity is multi-factorial and determined to a large extent by dietary habits, physical activity and sedentary behaviours. Previous research has shown that school-based programmes are effective but that their effectiveness can be improved by including a parental component. At present, there is a lack of effective parental support programmes for improvement of diet and physical activity and prevention of obesity in children. Methods/Design This paper describes the rationale and design of a parental support programme to promote healthy dietary habits and physical activity in six-year-old children starting school. The study is performed in close collaboration with the school health care and is designed as a cluster-randomised controlled trial with a mixed methods approach. In total, 14 pre-school classes are included from a municipality in Stockholm county where there is large variation in socio-economic status between the families. The school classes are randomised to intervention (n = 7 and control (n = 7 groups including a total of 242 children. The intervention is based on social cognitive theory and consists of three main components: 1 a health information brochure; 2 two motivational interviewing sessions with the parents; and 3 teacher-led classroom activities with the children. The primary outcomes are physical activity in the children measured objectively by accelerometry, children's dietary and physical activity habits measured with a parent-proxy questionnaire and parents' self-efficacy measured by a questionnaire. Secondary outcomes are height, weight and waist circumference in the children. The duration of the intervention is six months and includes baseline, post intervention and six months follow-up measurements. Linear and logistic regression models will be used to analyse differences between intervention and control groups in the outcome variables. Mediator and moderator analysis will be performed
Murphy, Susannah E; Longhitano, Carlo; Ayres, Rachael E; Cowen, Philip J; Harmer, Catherine J; Rogers, Robert D
Risky decision-making involves weighing good and bad outcomes against their probabilities in order to determine the relative values of candidate actions. Although human decision-making sometimes conforms to rational models of how this weighting is achieved, irrational (or nonnormative) patterns of risky choice, including shifts between risk-averse and risk-seeking choices involving equivalent-value gambles (the "reflection effect"), are frequently observed. In the present experiment, we investigated the role of serotonin in decision-making under conditions of uncertainty. Fifteen healthy adult volunteers received a treatment of 3 g per day of the serotonin precursor, tryptophan, in the form of dietary supplements over a 14-day period, whereas 15 age- and IQ-matched control volunteers received a matched placebo substance. At test, all participants completed a risky decision-making task involving a series of choices between two simultaneously presented gambles, differing in the magnitude of their possible gains, the magnitude of their possible losses, and the probabilities with which these outcomes were delivered. Tryptophan supplements were associated with alterations in the weighting of gains and small losses perhaps reflecting reduced loss-aversion, and a marked and significant diminution of the reflection effect. We conclude that serotonin activity plays a significant role in nonnormative risky decision-making under conditions of uncertainty.
Tyson, S F; Selley, A B
The Bobath concept is the predominant stroke physiotherapy approach in the UK but there is little literature about its operationalization. The aim of this study was to assess the effect of perceived adherence to the Bobath concept on interventions used by physiotherapists to treat postural control problems after stroke. The physiotherapists' experience, clinical grade and the type of patients treated were also compared. The design was a cross sectional survey involving 11 NHS Trusts. The participants were 35 stroke physiotherapists who recorded the treatment of 132 patients in 644 sessions using the Stroke Physiotherapy Intervention Recording Tool. Descriptive statistics, independent t-tests and Chi-squares were used in the analysis to describe the physiotherapists and patients, and compare the effects of perceived adherence to the Bobath concept on intervention choice, clinical grade, experience and the type of patient treated. Most physiotherapists perceived their practice to be eclectic but the interventions used followed a traditional Bobath model. Perceived adherence to the Bobath concept had little effect on the choice of intervention. The only significant difference was that 'preparation for treatment' techniques were used more frequently by 'strongly Bobath' physiotherapists then 'eclectic' physiotherapists. There were no other significant differences, nor were there any differences in the physiotherapists' clinical grade, post-graduate training or the type of patient treated except that 'eclectic' physiotherapists' patients were older. Most of the 'strongly Bobath' physiotherapists were experienced and most of the 'eclectic' physiotherapists were novices (pBobath model; recent developments of the Bobath concept were not incorporated into clinical practice. The reasons for the mismatch between physiotherapists' perception and their actual practice are discussed.
van Lenthe, Frank J; Jansen, Tessa; Kamphuis, Carlijn B M
Socio-economic groups differ in their material, living, working and social circumstances, which may result in different priorities about their daily-life needs, including the priority to make healthy food choices. Following Maslow's hierarchy of human needs, we hypothesised that socio-economic inequalities in healthy food choices can be explained by differences in the levels of need fulfilment. Postal survey data collected in 2011 (67·2 % response) from 2903 participants aged 20-75 years in the Dutch GLOBE (Gezondheid en Levens Omstandigheden Bevolking Eindhoven en omstreken) study were analysed. Maslow's hierarchy of human needs (measured with the Basic Need Satisfaction Inventory) was added to age- and sex-adjusted linear regression models that linked education and net household income levels to healthy food choices (measured by a FFQ). Most participants (38·6 %) were in the self-actualisation layer of the pyramid. This proportion was highest among the highest education group (47·6 %). Being in a higher level of the hierarchy was associated with a higher consumption of fruits and vegetables as well as more healthy than unhealthy bread, snack and dairy consumption. Educational inequalities in fruit and vegetable intake (B= -1·79, 95 % CI -2·31, -1·28 in the lowest education group) were most reduced after the hierarchy of needs score was included (B= -1·57, 95 % CI - ·09, -1·05). Inequalities in other healthy food choices hardly changed after the hierarchy of needs score was included. People who are satisfied with higher-level needs make healthier food choices. Studies aimed at understanding socio-economic inequalities in food choice behaviour need to take differences in the priority given to daily-life needs by different socio-economic groups into account, but Maslow's pyramid offers little help.
Savulescu has recently introduced the "rational non-interventional paternalist" model of the patient-doctor relationship. This paper addresses objections to such a model from the perspective of an anaesthetist. Patients need to make their own decisions if they are to be fully autonomous. Rational non-interventional paternalism undermines the importance of patient choice and so threatens autonomy. Doctors should provide an evaluative judgment of the best medical course of action, but ought to restrict themselves to helping patients to make their own choices rather than making such choices for them.
Kotler, Jennifer A; Schiffman, Jennifer M; Hanson, Katherine G
Two experiments were conducted to assess the role of media characters in influencing children's food choices; the first focused on children's self-reported preference, whereas the second focused on actual choice. The results of the experiments suggest that popular characters can make a difference in encouraging children to select one food over another. In the first experiment, children were more likely to indicate a preference for one food over another when one was associated with characters that they liked and with whom they were familiar. This effect was particularly strong when a sugary or salty snack branded by a favored character was competing with a healthier option branded by an unknown character or no character. Alternatively, when children were asked to choose between a healthy food and a sugary or salty snack, branding of the healthy food with a favored character did not significantly change appeal of that healthy snack. However, when foods within the same category (i.e., 2 vegetables, 2 fruits, or 2 grains) were asked to compete against each other, character branding strongly influenced children's food choice. Findings from the second experiment suggest that children are more willing to try more pieces of a healthy food if a favored character, in comparison with an unknown character, is promoting that food.
Ong Ken K
Full Text Available Abstract Background Improving nutrition knowledge among children may help them to make healthier food choices. The aim of this study was to assess the effectiveness and acceptability of a novel educational intervention to increase nutrition knowledge among primary school children. Methods We developed a card game 'Top Grub' and a 'healthy eating' curriculum for use in primary schools. Thirty-eight state primary schools comprising 2519 children in years 5 and 6 (aged 9-11 years were recruited in a pragmatic cluster randomised controlled trial. The main outcome measures were change in nutrition knowledge scores, attitudes to healthy eating and acceptability of the intervention by children and teachers. Results Twelve intervention and 13 control schools (comprising 1133 children completed the trial. The main reason for non-completion was time pressure of the school curriculum. Mean total nutrition knowledge score increased by 1.1 in intervention (baseline to follow-up: 28.3 to 29.2 and 0.3 in control schools (27.3 to 27.6. Total nutrition knowledge score at follow-up, adjusted for baseline score, deprivation, and school size, was higher in intervention than in control schools (mean difference = 1.1; 95% CI: 0.05 to 2.16; p = 0.042. At follow-up, more children in the intervention schools said they 'are currently eating a healthy diet' (39.6% or 'would try to eat a healthy diet' (35.7% than in control schools (34.4% and 31.7% respectively; chi-square test p Conclusions The 'Top Grub' card game facilitated the enjoyable delivery of nutrition education in a sample of UK primary school age children. Further studies should determine whether improvements in nutrition knowledge are sustained and lead to changes in dietary behaviour.
van der Laan, L.N.
Because of the health risks associated with unhealthy eating and overweight, it is important to better understand the motives underlying (un)healthy food choice. Explicit measures, such as questionnaires and focus groups, are suboptimal because they only tap into that specific part of the motive
Lin, Pei-Ying; Wood, Wendy; Monterosso, John
Can healthy food-choice habits protect people against temptations of consuming large portion sizes and unhealthy foods? In two studies, we show that the answer is yes, good habits serve this protective role, at least in contexts in which people are not deliberating and thus fall back on habitual responses. In the first study, participants trained with unhealthy habits to approach eating chocolate, but not those trained with healthy habits, succumbed to temptation and ate more chocolates when their self-control resources were depleted. Study 2 extended and clarified these findings by demonstrating the role of environmental cues in eliciting healthy habits when self-control resources are depleted. Participants who had been trained to choose carrots habitually to a pictorial stimulus (i.e., habit cue) subsequently resisted choosing M&Ms as long as the cue was present. This effect of habit cues on healthy food choices suggests the usefulness of manipulating such cues as a means of meeting self-regulatory goals such as portion control. Copyright © 2015 Elsevier Ltd. All rights reserved.
Skjøth, Mette Maria; Draborg, Eva; Lamont, Ronald Francis
INTRODUCTION: The aim of this study was to evaluate the effect of an eHealth intervention (interactive website) on pregnant women's ability to make an informed choice about Down syndrome screening. MATERIAL AND METHODS: The study was designed as a randomized controlled trial with allocation...... to an intervention group and a control group in a ratio of 1:1. Subsequent subgroup analysis was conducted. Participants were recruited from 5 August 2013 to 25 April 2014 at Odense University Hospital, Denmark. Inclusion criteria were: pregnant women aged ≥18 years who were invited to participate in Down syndrome...... screening. Exclusion criteria were: high risk of abortion, psycho-socially vulnerable women, late referral, inability to speak Danish and women declining to participate. The primary outcome was informed choice about Down syndrome screening. The Multidimensional Measure of Informed Choice was used to assess...
Knowlden, Adam P; Burns, Maranda; Harcrow, Andy; Shewmake, Meghan E
Poor sleep quality is a significant public health problem. The role of nutrition in predicting sleep quality is a relatively unexplored area of inquiry. The purpose of this study was to evaluate the capacity of 10 food choice categories, sleep confounding beverages, and psychological distress to predict the sleep quality of college students. A logistic regression model comprising 10 food choice variables (healthy proteins, unhealthy proteins, healthy dairy, unhealthy dairy, healthy grains, unhealthy grains, healthy fruits and vegetables, unhealthy empty calories, healthy beverages, unhealthy beverages), sleep confounding beverages (caffeinated/alcoholic beverages), as well as psychological distress (low, moderate, serious distress) was computed to determine the capacity of the variables to predict sleep quality (good/poor). The odds of poor sleep quality were 32.4% lower for each unit of increased frequency of healthy proteins consumed (pempty calorie food choices consumed (p=0.003; OR=1.131), and 107.3% higher for those classified in the moderate psychological distress (p=0.016; OR=2.073). Collectively, healthy proteins, healthy dairy, unhealthy empty calories, and moderate psychological distress were moderately predictive of sleep quality in the sample (Nagelkerke R2=23.8%). Results of the study suggested higher frequency of consumption of healthy protein and healthy dairy food choices reduced the odds of poor sleep quality, while higher consumption of empty calories and moderate psychological distress increased the odds of poor sleep quality.
Cáceda, Ricardo; Durand, Dante; Cortes, Edmi; Prendes-Alvarez, Stefania; Moskovciak, Tori; Harvey, Philip D; Nemeroff, Charles B
Despite identification of several risk factors, suicide prediction and prevention is still a clinical challenge. Suicide can be seen as a consequence of poor decision making triggered by overwhelming psychological pain. We examined the relationship of choice impulsivity and psychological pain in depressed patients with acute suicidality. Impulsive choice (delay discounting), psychological pain, and clinical characteristics were assessed in four groups of adults (N = 20-22): a) depressed patients within 72 hours after a suicide attempt, b) depressed patients with active suicidal ideation, c) nonsuicidal depressed patients, and d) healthy controls. Impulsive choice was higher in the suicide attempt (0.114 [0.027]) and ideation (0.099 [0.020]) groups compared with nonsuicidal depressed (0.079 [0.020]) and healthy (0.066 [0.019]) individuals (F(3,79) = 3.06, p = .042). Psychological pain data showed a similar profile (F(3,78) = 43.48, p suicide attempt, 54.3 (2.2) for suicide ideation, 37.0 (3.2) for nonsuicidal depressed, and 13.7 (0.5) for healthy groups. Within the suicide attempt group, persisting suicidal ideation was associated with more severe depression (36.6 [2.9] versus 21.5 [3.1], p = .007) and choice impulsivity (0.134 [0.03] versus 0.078 [0.04], p = .015). Both measures normalized within a week: depression (29.9 [2.6] versus 14.4 [3.0], p = .006) and choice impulsivity (0.114 [0.026] versus 0.066 [0.032], p = .019). Transient impulsive choice abnormalities are found in a subset of those who attempt suicide. Both, suicidal ideation and behavior were associated with choice impulsivity and intense psychological pain.
Ayala, Guadalupe X; Ibarra, Leticia; Horton, Lucy; Arredondo, Elva M; Slymen, Donald J; Engelberg, Moshe; Rock, Cheryl L; Hernandez, Erika; Parada, Humberto; Elder, John P
Entertainment education and the promotora model are 2 evidence-based health communication strategies. This study examined their combined effect on promoting healthy eating among mothers in a family-based intervention. Participants were 361 Mexican-origin families living in Imperial County, California, who were randomly assigned to an intervention or delayed treatment condition. The intervention involved promotoras (community health workers) who delivered 11 home visits and 4 telephone calls. Home visits included a 12-minute episode of a 9-part situation comedy depicting a family struggling with making healthy eating choices; an accompanying family workbook was reviewed to build skills and left with the family. Baseline and immediate postintervention data were collected from the mothers, including the primary outcome of daily servings of fruits and vegetables. Other dietary and psychosocial factors related to healthy eating were examined. At postintervention, mothers in the intervention reported increases in daily vegetable servings (p ≤ .05); however, no changes were observed in fruit consumption. Improvements were observed in behavioral strategies to increase fiber (p ≤ .001) and to decrease fat intake (p ≤ .001), unhealthy eating behaviors (p ≤ .001), and individual (p ≤ .05) and family-related (p ≤ .01) perceived barriers to healthy eating. Entertainment education and promotoras engaged families and improved mothers' diets. Further research should examine the dose needed for greater changes.
Full Text Available Abstract Background Multi-level, longer-term obesity prevention interventions that focus on inequalities are scarce. Fun ‘n healthy in Moreland! aimed to improve child adiposity, school policies and environments, parent engagement, health behaviours and child wellbeing. Methods All children from primary schools in an inner urban, culturally diverse and economically disadvantaged area in Victoria, Australia were eligible for participation. The intervention, fun ‘n healthy in Moreland!, used a Health Promoting Schools Framework and provided schools with evidence, school research data and part time support from a Community Development Worker to develop health promoting strategies. Comparison schools continued as normal. Participants were not blinded to intervention status. The primary outcome was change in adiposity. Repeated cross-sectional design with nested longitudinal subsample. Results Students from twenty-four primary schools (clusters were randomised (aged 5–12 years at baseline. 1426 students from 12 intervention schools and 1539 students from 10 comparison schools consented to follow up measurements. Despite increased prevalence of healthy weight across all schools, after 3.5 years of intervention there was no statistically significant difference between trial arms in BMI z score post-intervention (Mean (sd: Intervention 0.68(1.16; Comparison: 0.72(1.12; Adjusted mean difference (AMD: -0.05, CI: -0.19 to 0.08, p = 0.44. Children from intervention schools consumed more daily fruit serves (AMD: 0.19, CI:0.00 to 0.37, p = 0.10, were more likely to have water (AOR: 1.71, CI:1.05 to 2.78, p = 0.03 and vegetables (AOR: 1.23, CI: 0.99 to 1.55, p = 0.07, and less likely to have fruit juice/cordial (AOR: 0.58, CI:0.36 to 0.93, p = 0.02 in school lunch compared to children in comparison schools. More intervention schools (8/11 had healthy eating and physical activity policies compared with comparison schools (2/9. Principals and
Williams, Yvette Gail
Many children in U.S. K-12 schools struggle with childhood obesity. A healthy lifestyle taught in a child's early years is essential for student learning, and it can set the pace for healthy choices to be made in adulthood. The purpose of this exploratory case study was to explore the experiences of parents in Montgomery County, Ohio, who…
Croker, H; Whitaker, K L; Cooke, L; Wardle, J
To evaluate the effect of social norms on intended fruit and vegetable intake. A two-stage design to i) compare the perceived importance of normative influences vs cost and health on dietary choices, and ii) test the prediction that providing information on social norms will increase intended fruit and vegetable consumption in an experimental study. Home-based interviews (N=1083; 46% men, 54% women) were carried out as part of the Office for National Statistics Omnibus Survey in November 2008. The public's perception of the importance of social norms was lower (M=2.1) than the perceived importance of cost (M=2.7) or health (M=3.4) (all p'scost information; none of the interventions affected women's intentions. People have little awareness of the influence of social norms but normative information can have a demonstrable impact on dietary intentions. Health promotion might profit from emphasising how many people are attempting to adopt healthy lifestyles rather than how many have poor diets.
Diet-related chronic diseases are now a serious global public health problem. Public health groups are calling for the agricultural sector to play a greater role in tackling the threat. To identify potential points of policy intervention in the agricultural sector that could be leveraged to promote healthy diets and tackle obesity and diet-related chronic diseases. A review of the literature on the dietary implications of agriculture, a conceptual analysis of the issues, and the identification of relevant examples. There are two main potential points of intervention in the agricultural sector that could be leveraged to promote healthy diets: agricultural policies and agricultural production practices. Agricultural policies and practices affect diet through their influence on food availability, price, and nutrient quality, which in turn affects food choices available to consumers. Agricultural policies amenable to intervention include input, production, and trade policies; agricultural production practices amenable to intervention include crop breeding, crop fertilization practices, livestock-feeding practices, and crop systems diversity. It is well-known that agricultural policies and production practices influence what farmers choose to grow. Agricultural policies and production practices could also play a role in influencing what consumers choose to eat. To identify how agricultural policies and practices can usefully contribute toward promoting healthy diets and tackling obesity and diet-related chronic diseases, health policymakers need to examine whether current agricultural policies and production practices are contributing to-or detracting from-efforts to attain dietary goals; where and how could agricultural intervention help achieve dietary goals; and whether there are trade-offs between these interventions and other important concerns, such as undernutrition and the livelihoods of agricultural producers. Given the potential of agriculture to contribute to
Banos, Rosa M; Mensorio, Marinna S; Cebolla, Ausias; Rodilla, Enrique; Palomar, Gonzalo; Lisón, JuanFrancisco; Botella, Cristina
The prevalence of overweight and obesity is on the rise worldwide with severe physical and psychosocial consequences. One of the most dangerous is hypertension. Lifestyle changes related to eating behaviour and physical activity are the critical components in the prevention and treatment of hypertension and obesity. Data indicates that the usual procedures to promote these healthy habits in health services are either insufficient or not efficient enough. Internet has been shown to be an effective tool for the implementation of lifestyle interventions based on this type of problem. This study aims to assess the efficacy of a totally self-administered online intervention programme versus the usual medical care for obese and overweight participants with hypertension (from the Spanish public health care system) to promote healthy lifestyles (eating behaviour and physical activity). A randomized controlled trial will be conducted with 100 patients recruited from the hypertension unit of a public hospital. Participants will be randomly assigned to one of two conditions: a) SII: a self-administered Internet-based intervention protocol; and b) MUC-medical usual care. The online intervention is an Internet-delivered, multimedia, interactive, self-administered programme, composed of nine modules designed to promote healthy eating habits and increase physical activity. The first five modules will be activated at a rate of one per week, and access for modules 5 to 9 will open every two weeks. Patients will be assessed at four points: before the intervention, after the intervention (3 months), and at 6 and 12 months (follow-up). The outcome variables will include blood pressure, and Body Mass Index, as primary outcome measures, and quality of life and other lifestyle and anthropometrical variables as secondary outcome measures. The literature highlights the need for more studies on the benefits of using the Internet to promote lifestyle interventions. This study aims to
Pellegrini, Christine A; Steglitz, Jeremy; Johnston, Winter; Warnick, Jennifer; Adams, Tiara; McFadden, H G; Siddique, Juned; Hedeker, Donald; Spring, Bonnie
Suboptimal diet and inactive lifestyle are among the most prevalent preventable causes of premature death. Interventions that target multiple behaviors are potentially efficient; however the optimal way to initiate and maintain multiple health behavior changes is unknown. The Make Better Choices 2 (MBC2) trial aims to examine whether sustained healthful diet and activity change are best achieved by targeting diet and activity behaviors simultaneously or sequentially. Study design approximately 250 inactive adults with poor quality diet will be randomized to 3 conditions examining the best way to prescribe healthy diet and activity change. The 3 intervention conditions prescribe: 1) an increase in fruit and vegetable consumption (F/V+), decrease in sedentary leisure screen time (Sed-), and increase in physical activity (PA+) simultaneously (Simultaneous); 2) F/V+ and Sed- first, and then sequentially add PA+ (Sequential); or 3) Stress Management Control that addresses stress, relaxation, and sleep. All participants will receive a smartphone application to self-monitor behaviors and regular coaching calls to help facilitate behavior change during the 9 month intervention. Healthy lifestyle change in fruit/vegetable and saturated fat intakes, sedentary leisure screen time, and physical activity will be assessed at 3, 6, and 9 months. MBC2 is a randomized m-Health intervention examining methods to maximize initiation and maintenance of multiple healthful behavior changes. Results from this trial will provide insight about an optimal technology supported approach to promote improvement in diet and physical activity. Copyright © 2015 Elsevier Inc. All rights reserved.
Pridgeon, A; Whitehead, K
Workplaces are a key setting for improving the health of employees and influencing the health of the local population. The present study aimed to provide a deeper understanding of the perceptions and views of staff on the drivers and barriers to the provision, promotion and consumption of healthier food choices in two public sector workplaces. A mixture of catering and other staff (n = 23) employed by either Barnsley Metropolitan Borough Council or Barnsley Primary Care Trust were interviewed. Purposive sampling was used to ensure representation of different grades, job roles, hours worked, gender and age groups. All interviews were conducted in the workplace and were audio recorded, transcribed verbatim and analysed using framework analysis. Four themes that influence food and healthy eating in the workplace were identified: workplace structures and systems; cost, choice and availability of food; personal versus institutional responsibility; and food messages and marketing. Interviewees perceived that foods promoted in the workplace were traditional 'stodgy' foods and that there was a limited availability of affordable healthy choices. Catering staff were driven to run their service as a business rather than promote health. Time constraints and tight deadlines imposed on staff led to some not eating at midday. There is little qualitative research published about food in the workplace. This unique qualitative study has elicited staff views and experiences and suggests complexity around healthy eating and food provision in the workplace. The findings may inform the planning of future workplace interventions. © 2012 The Authors Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.
Tavares, Aida Isabel
People who decide to lose weight by dieting often do so without participating in any associated physical activity. Although some people who participate in sports are unconcerned about their diet, it is generally believed that people who exercise tend to eat a healthy diet and those who do not exercise eat a less healthy diet. There is no clear relationship between the decisions regarding participation in physical activity and eating a healthy diet when choices are taken freely and not influenced by policy factors promoting healthy behaviour. However, these decisions may reveal some common explanatory factors and an implicit link. As such the aim of this study was to identify the common explanatory factors and investigate the existence of an implicit relationship. Econometric estimate - bivariate probit estimation. Using data from the Portuguese National Health Survey, a bivariate probit was undertaken for decisions regarding participation in physical activity and eating a healthy diet. The correlation between the residuals gives information on the implicit relationship between the healthy choices. Common explanatory factors were found between the decisions to eat healthy snacks and participate in physical activity, such as being married. However, holding voluntary private health insurance, smoking, getting older, living alone and unemployment were found to dissuade people from making healthy choices. Positive correlation was found between the residuals of the probit estimations, indicating that other unmeasurable variables have a similar influence on both decisions, such as peer pressure, cultural values, fashion, advertising and risk aversion. Further research is needed to improve understanding of decision making related to participation in physical activity and eating a healthy diet. This will facilitate the design of policies that will make a greater contribution to healthy lifestyles. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier
Luten, Karla A.; Reijneveld, Sijmen A.; Dijkstra, Arie; de Winter, Andrea F.
The aim of this study is to assess the reach and effectiveness of an integrated community-based intervention designed to promote physical activity and healthy eating among older adults in a socioeconomically disadvantaged community in the Netherlands. The intervention was evaluated with a controlled pre-post quasi-experimental design, with 430…
Cha, EunSeok; Crowe, James M; Braxter, Betty J; Jennings, Bonnie Mowinski
To better understand health-related decision making among overweight and obese emerging adults. A cross-sectional design was used in the parent study involving overweight and obese emerging adults, ages 18-29 years. The goal of the parent study was to screen participants' diabetes risk and identify characteristics of emerging adults with prediabetes (N=107). A sub-sample of respondents (n=34) from the parent study were invited to participate in focus group interviews depending on whether they had prediabetes (three groups) or they did not have prediabetes (four groups). Each focus group interview lasted 90-120 minutes following a semi-structured interview guide. Conventional content analysis was used in the data analysis. Because of the similarities between participants with and without prediabetes, the findings were synthesized and reported in the aggregate. Moreover, during the analysis, the authors decided that rational choice theory provided a useful organizing structure for presenting the data. Emerging adults' behavioral decisions were rational reactions to their personal competence, perception of health, environment, and availability of resources to handle problems. Calculation of trade-offs and estimations of resource availability were often used when making decisions. Emerging adults choose unhealthy behaviors due to inaccurate information and insufficient competence to practice healthy lifestyles rather than because of laziness or being irrational. Behavioral interventions for emerging adults need to help them develop skills to enhance health literacy and problem solving, thereby enhancing their awareness of available resources and decreasing the perceived cost of making healthy choices. Copyright Â© 2016 Elsevier Inc. All rights reserved.
Moeller, S.J.; Goldstein, R.; Moeller, S.J.; Maloney, T.; Parvaz, M.A.; Dunning, J.P.; Alia-Klein, N.; Woicik, P.A.; Hajcak, G.; Telang, F.; Wang, G.-J.; Volkow, N.D.; Goldstein, R.Z.
Individuals with cocaine use disorder (CUD) chose cocaine over nondrug rewards. In two newly designed laboratory tasks with pictures, we document this modified choice outside of a cocaine administration paradigm. Choice for viewing cocaine, pleasant, unpleasant, or neutral pictures-under explicit contingencies (choice made between two fully visible side-by-side images) and under more implicit contingencies (selections made between pictures hidden under flipped-over cards)-was examined in 20 CUD and 20 matched healthy control subjects. Subjects also provided self-reported ratings of each picture's pleasantness and arousal. Under both contingencies, CUD subjects chose to view more cocaine pictures than control subjects, group differences that were not fully explained by the self-reported picture ratings. Furthermore, whereas CUD subjects choice for viewing cocaine pictures exceeded choice for viewing unpleasant pictures (but did not exceed choice for viewing pleasant pictures, in contrast to their self-reported ratings), healthy control subjects avoided viewing cocaine pictures as frequently as, or even more than, unpleasant pictures. Finally, CUD subjects with the most cocaine viewing selections, even when directly compared with selections of the pleasant pictures, also reported the most frequent recent cocaine use. Enhanced drug-related choice in cocaine addiction can be demonstrated even for nonpharmacologic (pictorial) stimuli. This choice, which is modulated by alternative stimuli, partly transcends self-reports (possibly indicative of a disconnect in cocaine addiction between self-reports and objective behavior) to provide an objective marker of addiction severity. Neuroimaging studies are needed to establish the neural underpinnings of such enhanced cocaine-related choice.
Moeller, S.J.; Goldstein, R.; Moeller, S.J.; Maloney, T. Parvaz, M.A.; Dunning, J.P.; Alia-Klein, N.; Woicik, P.A.; Hajcak, G.; Telang, F.; Wang, G.-J.; Volkow, N.D.; Goldstein, R.Z.
Individuals with cocaine use disorder (CUD) chose cocaine over nondrug rewards. In two newly designed laboratory tasks with pictures, we document this modified choice outside of a cocaine administration paradigm. Choice for viewing cocaine, pleasant, unpleasant, or neutral pictures-under explicit contingencies (choice made between two fully visible side-by-side images) and under more implicit contingencies (selections made between pictures hidden under flipped-over cards)-was examined in 20 CUD and 20 matched healthy control subjects. Subjects also provided self-reported ratings of each picture's pleasantness and arousal. Under both contingencies, CUD subjects chose to view more cocaine pictures than control subjects, group differences that were not fully explained by the self-reported picture ratings. Furthermore, whereas CUD subjects choice for viewing cocaine pictures exceeded choice for viewing unpleasant pictures (but did not exceed choice for viewing pleasant pictures, in contrast to their self-reported ratings), healthy control subjects avoided viewing cocaine pictures as frequently as, or even more than, unpleasant pictures. Finally, CUD subjects with the most cocaine viewing selections, even when directly compared with selections of the pleasant pictures, also reported the most frequent recent cocaine use. Enhanced drug-related choice in cocaine addiction can be demonstrated even for nonpharmacologic (pictorial) stimuli. This choice, which is modulated by alternative stimuli, partly transcends self-reports (possibly indicative of a disconnect in cocaine addiction between self-reports and objective behavior) to provide an objective marker of addiction severity. Neuroimaging studies are needed to establish the neural underpinnings of such enhanced cocaine-related choice.
Salmoirago-Blotcher, Elena; Druker, Sue; Meyer, Florence; Bock, Beth; Crawford, Sybil; Pbert, Lori
Cardiovascular prevention is more effective if started early in life, but available interventions to promote healthy lifestyle habits among youth have been ineffective. Impulsivity in particular has proven to be an important barrier to the adoption of healthy behaviors in youth. Observational evidence suggests that mindfulness interventions may reduce impulsivity and improve diet and physical activity. We hypothesize that mindfulness training in adjunct to traditional health education will improve dietary habits and physical activity among teenagers by reducing impulsive behavior and improving planning skills. The Commit to Get Fit study is a pilot cluster randomized controlled trial examining the feasibility, acceptability and preliminary efficacy of school-based mindfulness training in adjunct to traditional health education for promotion of a healthy diet and physical activity among adolescents. Two schools in central Massachusetts (30 students per school) will be randomized to receive mindfulness training plus standard health education (HE-M) or an attention-control intervention plus standard health education (HE-AC). Assessments will be conducted at baseline, intervention completion (2 months), and 8 months. Primary outcomes are feasibility and acceptability. Secondary outcomes include physical activity, diet, impulsivity, mood, body mass index, and quality of life. This study will provide important information about feasibility and preliminary estimates of efficacy of a school-delivered mindfulness and health education intervention to promote healthy dietary and physical activity behaviors among adolescents. Our findings will provide important insights about the possible mechanisms by which mindfulness training may contribute to behavioral change and inform future research in this important area. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available The aim of this systematic review was to assess the effect of diet on changes in parameters describing the body size phenotype of metabolically healthy obese subjects. The databases Medline, Scopus, Web of Knowledge and Embase were searched for clinical studies carried out between 1958 and June 2016 that reported the effect of dietary intervention on BMI, blood pressure, concentration of fasting triglyceride (TG, high density lipoprotein cholesterol (HDL-C, fasting glucose level, the homoeostatic model assessment of insulin resistance (HOMA-IR and high sensitivity C-Reactive Protein (hsCRP in metabolically healthy, obese subjects. Twelve clinical studies met inclusion criteria. The combined analyzed population consists of 1827 subjects aged 34.4 to 61.1 with a BMI > 30 kg/m2. Time of intervention ranged from eight to 104 weeks. The baseline characteristics related to lipid profile were more favorable for metabolically healthy obese than for metabolically unhealthy obese. The meta-analyses revealed a significant associations between restricted energy diet and BMI (95% confidence interval (CI: −0.88, −0.19, blood pressure (systolic blood pressure (SBP: −4.73 mmHg; 95% CI: −7.12, −2.33; and diastolic blood pressure (DBP: −2.75 mmHg; 95% CI: −4.30, −1.21 and TG (−0.11 mmol/l; 95% CI: −0.16, −0.06. Changes in fasting glucose, HOMA-IR and hsCRP did not show significant changes. Sufficient evidence was not found to support the use of specific diets in metabolically healthy obese subjects. This analysis suggests that the effect of caloric restriction exerts its effects through a reduction in BMI, blood pressure and triglycerides in metabolically healthy obese (MHO patients.
... seven locations where the program will take place and the criteria used for selection; and (2) the... more physically active, and offering more healthy food choices in worksite cafeterias and vending..., nutrition counseling/education, menu labeling on healthy foods, healthy foods in cafeterias and vending...
French, Simone A; Hannan, Peter J; Harnack, Lisa J; Mitchell, Nathan R; Toomey, Traci L; Gerlach, Anne
To evaluate the effects of lowering prices and increasing availability on sales of healthy foods and beverages from 33 vending machines in 4 bus garages as part of a multicomponent worksite obesity prevention intervention. Availability of healthy items was increased to 50% and prices were lowered at least 10% in the vending machines in two metropolitan bus garages for an 18-month period. Two control garages offered vending choices at usual availability and prices. Sales data were collected monthly from each of the vending machines at the four garages. Increases in availability to 50% and price reductions of an average of 31% resulted in 10% to 42% higher sales of the healthy items. Employees were mostly price responsive for snack purchases. Greater availability and lower prices on targeted food and beverage items from vending machines was associated with greater purchases of these items over an 18-month period. Efforts to promote healthful food purchases in worksite settings should incorporate these two strategies.
Temple, Norman J; Steyn, Nelia P
Energy-dense foods are relatively cheap sources of energy but typically have a low nutrient density. People with a low income may therefore select a relatively less healthy diet. The high energy density of such diets helps explain the association between obesity and low socioeconomic status. Most studies have been carried out in highly developed countries. We have extended this research to South Africa. Some foods, such as oats, beans, carrots, and apples, are moderately priced sources of energy and are healthy (i.e., they have a low energy density and are nutrient dense). However, such foods are likely to be less desired than many other foods, such as candy, cookies, jam, and chocolate, that have a similar cost (in terms of food energy) but are less healthy. We compared the cost of a typical South African diet with a healthier one. On average, the healthier diet costs 69% more, but this estimate is greatly affected by food choices. For a family whose household income is exceeded by one-third of the population, this increased expenditure represents about 30% of total household income. This could be decreased to about 10% to 15% if a healthy diet is carefully designed. Overall, a healthy diet is unaffordable for most South Africans. This shows the importance of not only educating people in developing countries to the importance of a healthy diet but also explaining how to make such a diet affordable. A more effective strategy is government intervention that manipulates food prices. Copyright © 2011 Elsevier Inc. All rights reserved.
Lennon, Olive C; Doody, Catherine; Ni Choisdealbh, Cliodhna; Blake, Catherine
The aim of the study was to explore community-dwelling stroke patients' perceived barriers to healthy-lifestyle participation for secondary disease prevention, as well as their preferred means for risk-reduction information dissemination and motivators to participation in healthy-lifestyle interventions. Four focus groups (5-6 stroke survivors per group) were defined from community support groups. Key questions addressed barriers to healthy-lifestyle adoption, preferred methods for receiving information and factors that would engage participants in a risk-reduction programme. Groups were audiotaped, transcribed verbatim and analysed for thematic content using a framework approach. Twenty-two participants, 12 men, 10 women, mean age 71.4 (53-87) years, were included in the study. Three overarching themes emerged as barriers to healthy-lifestyle participation: physical, mental and environmental. Exercise participation difficulties spread across all three themes; healthy eating and smoking cessation concentrated in environmental and mental dimensions. Talks (discussions) were noted as participants' preferred method of information provision. Risk-reduction programmes considered attractive were stroke specific, convenient and delivered by healthcare professionals and involved both social and exercise components. Many stroke patients appear unable to adopt healthy-lifestyle changes through advice alone because of physical, mental and environmental barriers. Risk-reduction programmes including interactive education should be specifically tailored to address barriers currently experienced and extend beyond the stroke survivor to others in their environment who influence lifestyle choices.
Kuijer, Roeline G; Boyce, Jessica A; Marshall, Emma M
The increase in obesity and the many educational messages prompting us to eat a healthy diet have heightened people's concerns about the effects of food choice on health and weight. An unintended side effect may be that such awareness fuels feelings of guilt and worry about food. Although guilt has the potential to motivate behaviour change, it may also lead to feelings of helplessness and loss of control. The current study examined the relationship between a default association of either 'guilt' or 'celebration' with a prototypical forbidden food item (chocolate cake), indicators of healthy eating and choosing food for mood regulation reasons. Following a 'diathesis-stress' perspective, the moderating roles of depressive symptoms and stress were examined. Although a default association of guilt was found to be harmless under some circumstances (i.e. under low stress), those who associated chocolate cake with guilt (vs. celebration) reported unhealthier eating habits and lower levels of perceived behavioural control over healthy eating when under stress, rated mood regulation reasons for food choice as important irrespective of their current affective state, and did not have more positive attitudes towards healthy eating. Implications for public health messages and interventions will be discussed.
Kelly, Bridget; Flood, Victoria M; Bicego, Cecilia; Yeatman, Heather
Train stations provide opportunities for food purchases and many consumers are exposed to these venues daily, on their commute to and from work. This study aimed to describe the food environment that commuters are exposed to at train stations in NSW. One hundred train stations were randomly sampled from the Greater Sydney Metropolitan region, representing a range of demographic areas. A purpose-designed instrument was developed to collect information on the availability, promotion and cost of food and beverages in vending machines. Items were classified as high/low in energy according to NSW school canteen criteria. Of the 206 vending machines identified, 84% of slots were stocked with high-energy food and beverages. The most frequently available items were chips and extruded snacks (33%), sugar-sweetened soft drinks (18%), chocolate (12%) and confectionery (10%). High energy foods were consistently cheaper than lower-energy alternatives. Transport sites may cumulatively contribute to excess energy consumption as the items offered are energy dense. Interventions are required to improve train commuters' access to healthy food and beverages.
Moeller, Scott J.; Hajcak, Greg; Parvaz, Muhammad A.; Dunning, Jonathan P.; Volkow, Nora D.
An important goal of addiction research and treatment is to predict behavioural responses to drug-related stimuli. This goal is especially important for patients with impaired insight, which can interfere with therapeutic interventions and potentially invalidate self-report questionnaires. This research tested (i) whether event-related potentials, specifically the late positive potential, predict choice to view cocaine images in cocaine addiction; and (ii) whether such behaviour prediction differs by insight (operationalized in this study as self-awareness of image choice). Fifty-nine cocaine abusers and 32 healthy controls provided data for the following laboratory components that were completed in a fixed-sequence (to establish prediction): (i) event-related potential recordings while passively viewing pleasant, unpleasant, neutral and cocaine images, during which early (400–1000 ms) and late (1000–2000 ms) window late positive potentials were collected; (ii) self-reported arousal ratings for each picture; and (iii) two previously validated tasks: one to assess choice for viewing these same images, and the other to group cocaine abusers by insight. Results showed that pleasant-related late positive potentials and arousal ratings predicted pleasant choice (the choice to view pleasant pictures) in all subjects, validating the method. In the cocaine abusers, the predictive ability of the late positive potentials and arousal ratings depended on insight. Cocaine-related late positive potentials better predicted cocaine image choice in cocaine abusers with impaired insight. Another emotion-relevant event-related potential component (the early posterior negativity) did not show these results, indicating specificity of the late positive potential. In contrast, arousal ratings better predicted respective cocaine image choice (and actual cocaine use severity) in cocaine abusers with intact insight. Taken together, the late positive potential could serve as a biomarker
Full Text Available Abstract Background The largest single cause of death among people with severe mental disorders is cardiovascular disease (CVD. The majority of people with schizophrenia and bipolar disorder smoke and many are also overweight, considerably increasing their risk of CVD. Treatment for smoking and other health risk behaviours is often not prioritized among people with severe mental disorders. This protocol describes a study in which we will assess the effectiveness of a healthy lifestyle intervention on smoking and CVD risk and associated health behaviours among people with severe mental disorders. Methods/Design 250 smokers with a severe mental disorder will be recruited. After completion of a baseline assessment and an initial face-to-face intervention session, participants will be randomly assigned to either a multi-component intervention for smoking cessation and CVD risk reduction or a telephone-based minimal intervention focusing on smoking cessation. Randomisation will be stratified by site (Newcastle, Sydney, Melbourne, Australia, Body Mass Index (BMI category (normal, overweight, obese and type of antipsychotic medication (typical, atypical. Participants will receive 8 weekly, 3 fortnightly and 6 monthly sessions delivered face to face (typically 1 hour or by telephone (typically 10 minutes. Assessments will be conducted by research staff blind to treatment allocation at baseline, 15 weeks, and 12-, 18-, 24-, 30- and 36-months. Discussion This study will provide comprehensive data on the effect of a healthy lifestyle intervention on smoking and CVD risk among people with severe mental disorders. If shown to be effective, this intervention can be disseminated to treating clinicians using the treatment manuals. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR identifier: ACTRN12609001039279
Cho, Young-Hee; Mohamed, Olfat; White, Barbara; Singh-Carlson, Savitri; Krishnan, Vennila
Multicomponent intervention programs have been shown to be effective in reducing risk factors associated with falls, but the primary target population of these interventions is often low-functioning older adults. The purpose of this study was to investigate the effectiveness of a multicomponent intervention program focusing on balance and muscle strength for independently functioning community-dwelling older adults. Fifty-three independently functioning older adults, aged 80.09 ± 6.62 years, participated in a group exercise class (conducted 2 times/week for 8 weeks) emphasizing balance. Outcome measures were balance performance using the Fullerton Advanced Balance (FAB) scale and muscle strength using the Senior Fitness Test (SFT). The intervention improved balance (P older adults who were classified as having high fall risks based on the FAB scores at pre-testing improved more than older adults who were classified as having low fall risks (P = 0.017). As a result, 22 participants transitioned from a high fall risk group at pre-testing to a low fall risk group at post-testing (P fall risk status. The multicomponent intervention conducted two times per week for 8 weeks was effective in improving balance and enhancing muscle strength of independently functioning older adults. The results underscore the importance of providing fall prevention interventions to healthy older adults, a population often not a target of balance interventions.
Chee Khoon Chan
In parallel with the neo-liberal retrenchment of the welfarist state, an increasing emphasis on the responsibility of individuals in managing their own affairs and their well-being has been evident. In the health arena for instance, this was a major theme permeating the UK government's White Paper Choosing Health: Making Healthy Choices Easier (2004), which appealed to an ethos of autonomy and self-actualization through activity and consumption which merited esteem. As a counterpoint to this growing trend of informed responsibilization, constrained choices (constrained agency) provides a useful framework for a judicious balance and sense of proportion between an individual behavioural focus and a focus on societal, systemic, and structural determinants of health and well-being. Constrained choices is also a conceptual bridge between responsibilization and population health which could be further developed within an integrative biosocial perspective one might refer to as the social ecology of health and disease.
Sanada, Kenji; Alda Díez, Marta; Salas Valero, Montserrat; Pérez-Yus, María C; Demarzo, Marcelo M P; Montero-Marín, Jesús; García-Toro, Mauro; García-Campayo, Javier
Only a small number of articles have investigated the relationship between mindfulness-based interventions (MBIs) and biomarkers. The aim of this systematic review was to study the effect of MBIs on specific biomarkers (cytokines, neuropeptides and C-reactive protein (CRP)) in both healthy subjects and cancer patients. A search was conducted using PubMed, EMBASE, PsycINFO and the Cochrane library between 1980 and September 2016. A total of 13 studies with 1110 participants were included. In the healthy population, MBIs had no effect on cytokines, but were found to increase the levels of the neuropeptide insulin-like growth factor 1 (IGF-1). With respect to neuropeptide Y, despite the absence of post-intervention differences, MBIs may enhance recovery from stress. With regard to CRP, MBIs could be effective in lower Body Mass Index (BMI) individuals. In cancer patients, MBIs seem to have some effect on cytokine levels, although it was not possible to determine which specific cytokines were affected. One possibility is that MBIs might aid recovery of the immune system, increasing the production of interleukin (IL)-4 and decreasing interferon gamma (IFN-γ). MBIs may be involved in changes from a depressive/carcinogenic profile to a more normalized one. However, given the complexity and different contexts of the immune system, and the fact that this investigation is still in its preliminary stage, additional randomized controlled trials are needed to further establish the impact of MBI programmes on biomarkers in both clinical and non-clinical populations.
Peterson, Jennifer R; Hill, Catherine C; Marshall, Andrew T; Stuebing, Sarah L; Kirkpatrick, Kimberly
Impulsive choice behavior occurs when individuals make choices without regard for future consequences. This behavior is often maladaptive and is a common symptom in many disorders, including drug abuse, compulsive gambling, and obesity. Several proposed mechanisms may influence impulsive choice behavior. These mechanisms provide a variety of pathways that may provide the basis for individual differences that are often evident when measuring choice behavior. This review provides an overview of these different pathways to impulsive choice, and the behavioral intervention strategies being developed to moderate impulsive choice. Because of the compelling link between impulsive choice behavior and the near-epidemic pervasiveness of obesity in the United States, we focus on the relationship between impulsive choice behavior and obesity as a test case for application of the multiple pathways approach. Choosing immediate gratification over healthier long term food choices is a contributing factor to the obesity crisis. Behavioral interventions can lead to more self controlled choices in a rat pre-clinical model, suggesting a possible gateway for translation to human populations. Designing and implementing effective impulsive choice interventions is crucial to improving the overall health and well-being of impulsive individuals.
Bird, M; Hill, K D; Ball, M; Hetherington, S; Williams, A D
We examined the long-term effects of a multi-component exercise program on balance, mobility and exercise behavior. The benefits of a community-based resistance and flexibility exercise intervention in a group of healthy older (60-75 years) individuals were recorded 12 months after completion of the randomized control intervention. Differences between those participants who continued to exercise and those who discontinued were investigated. Significant improvements from baseline in sit to stand (pexercise intervention group, with a control group unchanged. Participants who continued exercising had significantly greater improvements in strength immediately after the intervention, compared to those who discontinued (p=0.004). Those who continued regular resistance training performed better in the step test at 12-month follow up (p=0.009) and believed that the program was of more benefit to their physical activity (pexercising. Benefits to balance and mobility persist 1 year after participation in a multi-component exercise program, due in part to some continuing participation in resistance training. Motivation to continue resistance training may be related real and perceived benefits attained from the intervention as well as the environmental context of the intervention. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Thunström, Linda; Nordström, Leif Jonas; Shogren, Jason
Menu labelling of meals prepared away from home is a policy designed to help consumers make healthier food choices. In this paper we use a field experiment in Sweden to examine if a restaurant benefits from introducing a meal labelled as healthy on its menu by experiencing an overall increase...... in sales. We cannot reject the hypothesis that sales are the same before and after the introduction of a meal labelled as healthy on the menu, i.e. our data does not support the idea that restaurants increase their sales from supplying a meal labelled as healthy....
Skouteris, Helen; Edwards, Susan; Rutherford, Leonie; Cutter-MacKenzie, Amy; Huang, Terry; O'Connor, Amanda
This paper details the research protocol for a study funded by the Australian Research Council. An integrated approach towards helping young children respond to the significant pressures of '360 degree marketing' on their food choices, levels of active play, and sustainability consciousness via the early childhood curriculum is lacking. The overall goal of this study is to evaluate the efficacy of curriculum interventions that educators design when using a pedagogical communication strategy on children's knowledge about healthy eating, active play and the sustainability consequences of their toy food and toy selections. This cluster-randomised trial will be conducted with 300, 4 to 5 year-old children attending pre-school. Early childhood educators will develop a curriculum intervention using a pedagogical communication strategy that integrates content knowledge about healthy eating, active play and sustainability consciousness and deliver this to their pre-school class. Children will be interviewed about their knowledge of healthy eating, active play and the sustainability consequences of their food and toy selections. Parents will complete an Eating and Physical Activity Questionnaire rating their children's food preferences, digital media viewing and physical activity habits. All measures will be administered at baseline, the end of the intervention and 6 months post intervention. Informed consent will be obtained from all parents and the pre-school classes will be allocated randomly to the intervention or wait-list control group. This study is the first to utilise an integrated pedagogical communication strategy developed specifically for early childhood educators focusing on children's healthy eating, active play, and sustainability consciousness. The significance of the early childhood period, for young children's learning about healthy eating, active play and sustainability, is now unquestioned. The specific teaching and learning practices used by early
Helland-Kigen, Kaja Marie; Råberg Kjøllesdal, Marte Karoline; Hjellset, Victoria Telle; Bjørge, Benedikte; Holmboe-Ottesen, Gerd; Wandel, Margareta
To investigate maintenance of changes in food intake and motivation for healthy eating at follow-up 2 data collection after a lifestyle intervention among Pakistani immigrant women. A culturally adapted lifestyle intervention, aiming at reducing the risk of type 2 diabetes mellitus. Data collection including FFQ and questions on intentions to change dietary behaviour was completed at baseline, right after the 7 ± 1 month intervention (follow-up 1) and 2-3 years after baseline (follow-up 2). Oslo, Norway. Pakistani women (n =198), aged 25-60 years, randomized into control and intervention groups. From follow-up 1 to follow-up 2 there was a shift from action to maintenance stages for intention to reduce fat intake (P diet.
Rohde, Jeanett F; Larsen, Sofus C; Ängquist, Lars; Olsen, Nanna J; Stougaard, Maria; Mortensen, Erik L; Heitmann, Berit L
The study aimed to evaluate the impact of a 15-month intervention on dietary intake conducted among obesity-prone normal-weight pre-school children. Information on dietary intake was obtained using a 4 d diet record. A diet quality index was adapted to assess how well children's diet complied with the Danish national guidelines. Linear regression per protocol and intention-to-treat analyses of differences in intakes of energy, macronutrients, fruit, vegetables, fish, sugar-sweetened beverages and diet quality index between the two groups were conducted. The Healthy Start study was conducted during 2009-2011, focusing on changing diet, physical activity, sleep and stress management to prevent excessive weight gain among Danish children. From a population of 635 Danish pre-school children, who had a high birth weight (≥4000 g), high maternal pre-pregnancy BMI (≥28·0 kg/m2) or low maternal educational level (dietary intake. Children in the intervention group had a lower energy intake after the 15-month intervention (group means: 5·29 v. 5·59 MJ, P=0·02) compared with the control group. We observed lower intakes of carbohydrates and added sugar in the intervention group compared with the control group after the intervention (P=0·002, P=0·01). The intervention resulted in a lower energy intake, particularly from carbohydrates and added sugar after 15 months of intervention, suggesting that dietary intake can be changed in a healthier direction in children predisposed to obesity.
Full Text Available After a long period of stagnation, traditionally explained by the voluntary nature of the programme, a considerable increase in routine measles vaccine uptake has been recently observed in Italy after a set of public interventions aiming to promote MMR immunization, whilst retaining its voluntary aspect. To account for this take-off in coverage we propose a simple SIR transmission model with vaccination choice, where, unlike similar works, vaccinating behaviour spreads not only through the diffusion of "private" information spontaneously circulating among parents of children to be vaccinated, which we call imitation, but also through public information communicated by the public health authorities. We show that public intervention has a stabilising role which is able to reduce the strength of imitation-induced oscillations, to allow disease elimination, and to even make the disease-free equilibrium where everyone is vaccinated globally attractive. The available Italian data are used to evaluate the main behavioural parameters, showing that the proposed model seems to provide a much more plausible behavioural explanation of the observed take-off of uptake of vaccine against measles than models based on pure imitation alone.
Munt, A E; Partridge, S R; Allman-Farinelli, M
Young adults in Western countries are gaining weight faster than their parents and are more likely to gain weight than any other age cohort. Despite this, investigation into the complex young adults' food choice motives, which enable and prevent healthy eating, has not been widely investigated. A scoping review was conducted involving an extensive literature search of four major electronic databases: Medline, Embase, PsychInfo and CINAHL. Data were collected from 34 articles: study descriptions numerically analysed and key findings thematically analysed. The key barriers found included: male apathy towards diet; unhealthy diet of friends and family; expected consumption of unhealthy foods in certain situations; relative low cost of unhealthy foods; lack of time to plan, shop, prepare and cook healthy foods; lack of facilities to prepare, cook and store healthy foods; widespread presence of unhealthy foods; lack of knowledge and skills to plan, shop, prepare and cook healthy foods; lack of motivation to eat healthily (including risk-taking behaviour). The key enablers found included: female interest in a healthy diet; healthy diet of friends and family; support/encouragement of friends and family to eat healthy; desire for improved health; desire for weight management; desire for improved self-esteem; desire for attractiveness to potential partners and others; possessing autonomous motivation to eat healthy and existence and use of self-regulatory skills. This research provides evidence that can be used to tailor interventions for healthy eating and overweight and obesity in this population. However, government intervention in addressing food access, affordability, marketing and taxation remains essential to any significant change. © 2016 World Obesity Federation.
Schickenberg, B; van Assema, P; Brug, J; de Vries, N K
The purpose of this study was to assess whether the availability of a product sample of an unfamiliar low-fat or fruit and vegetable products stimulates choice for this product among food neophobic young adults. The study had a 2 (experimental vs. control group) by 4 (low-fat bread spread, low-fat cheese, fruit juice, fruit and vegetable juice) between subjects design with a pre-and post-experiment questionnaire. The study was conducted in restaurant rooms of several educational institutions in the Netherlands among a convenience sample of 197 food neophobic young adults aged 17-25 years. A small bite or sip-sized sample of the target product was provided as an intervention. The effect measure was choice of either an unfamiliar healthful food product or a traditional food product. Offering a sample of an unfamiliar healthful food product resulted in 51% of the participants in the experimental group choosing this product vs. 36.4% in the control group. Providing food product samples seems to be a promising strategy in healthy diet promotion programs for food neophobic young adults to increase first-time trial of unfamiliar low-fat and fruit and vegetable products. Copyright © 2011 Elsevier Ltd. All rights reserved.
Kalich, Karrie; Bauer, Dottie; McPartlin, Deirdre
Plant lifelong healthy eating concepts in young children and counteract the prevalence of childhood obesity with "Early Sprouts." A research-based early childhood curriculum, this "seed-to-table" approach gets children interested in and enjoying nutritious fruits and vegetables. The "Early Sprouts" model engages…
McDarby, F; O'Hora, D; O'Shea, D; Byrne, M
Drink personalization (featuring names on bottle labels) has been used by soft drink companies to make their drinks attractive to children, potentially increasing consumption. To date, no publically available research has evaluated the influence of personalization on children's drink choices. To determine (i) whether personalizing bottled drinks influences children's drink choices; (ii) whether it is comparably effective in promoting healthy and unhealthy drinks and (iii) whether drink choices are affected by self-esteem, body mass index and parental factors. Children aged 8-13 years (N = 404) were randomly assigned to one of three drink labeling conditions: Prime Healthy, Prime Unhealthy and Control. All participants selected one beverage from 12 options, comprising six healthy and unhealthy drinks. Personalizing healthy drinks increased choice of healthy drinks (OR, 2.21; 95% CI, 1.24-4.00), and personalizing unhealthy drinks reduced choice of healthy drinks (OR, 0.35; 95% CI, 0.15-.0.75). Higher self-esteem predicted choosing own-named drinks (OR = 1.08, 95% CI, 1.00-1.18; p = .049). Children's drink choices are influenced by personalizing drink bottles. Tighter regulation of this marketing strategy for soft drinks may reduce children choice of these drinks. Personalization may also be used to encourage children to choose healthy drinks. © 2016 World Obesity Federation.
Bravender, Terrill; Tulsky, James A.; Farrell, David; Alexander, Stewart C.; Østbye, Truls; Lyna, Pauline; Dolor, Rowena J.; Coffman, Cynthia J.; Bilheimer, Alicia; Lin, Pao-Hwa; Pollak, Kathryn I.
Objective To describe the theoretical basis, use, and satisfaction with Teen CHAT, an online educational intervention designed to improve physician-adolescent communication about healthy weight. Methods Routine health maintenance encounters between pediatricians and family practitioners and their overweight adolescent patients were audio recorded, and content was coded to summarize adherence with motivational interviewing techniques. An online educational intervention was developed using constructs from social cognitive theory and using personalized audio recordings. Physicians were randomized to the online intervention or not, and completed post-intervention surveys. Results Forty-six physicians were recruited, and 22 physicians were randomized to view the intervention website. The educational intervention took an average of 54 minutes to complete, and most physicians thought it was useful, that they would use newly acquired skills with their patients, and would recommend it to others. Fewer physicians thought it helped them address confidentiality issues with their adolescent patients. Conclusion The Teen CHAT online intervention shows potential for enhancing physician motivational interviewing skills in an acceptable and time-efficient manner. Practice Implications If found to be effective in enhancing motivational interviewing skills and changing adolescent weight-related behaviors, wide dissemination will be feasible and indicated. PMID:24021419
Gandini, Delphine; Lemaire, Patrick; Michel, Bernard Francois
Forty young adults, 40 healthy older adults, and 39 probable AD patients were asked to estimate small (e.g., 25) and large (e.g., 60) collections of dots in a choice condition and in two no-choice conditions. Participants could choose between benchmark and anchoring strategies on each collection of dots in the choice condition and were required to…
Sarmiento, Juan Pablo
Purpose: The purpose of this paper is to map out and characterize existing health-promotion initiatives at Florida International University (FIU) in the USA in order to inform decision makers involved in the development of a comprehensive and a long-term healthy university strategy. Design/methodology/approach: This study encompasses a narrative…
Niebylski, Mark L.; Lu, Tammy; Campbell, Norm R. C.; Arcand, Joanne; Schermel, Alyssa; Hua, Diane; Yeates, Karen E.; Tobe, Sheldon W.; Twohig, Patrick A.; L’Abbé, Mary R.; Liu, Peter P.
Unhealthy eating is the leading risk for death and disability globally. As a result, the World Health Organization (WHO) has called for population health interventions. One of the proposed interventions is to ensure healthy foods are available by implementing healthy food procurement policies. The objective of this systematic review was to evaluate the evidence base assessing the impact of such policies. A comprehensive review was conducted by searching PubMed and Medline for policies that had been implemented and evaluated the impact of food purchases, food consumption, and behaviors towards healthy foods. Thirty-four studies were identified and found to be effective at increasing the availability and purchases of healthy food and decreasing purchases of unhealthy food. Most policies also had other components such as education, price reductions, and health interventions. The multiple gaps in research identified by this review suggest that additional research and ongoing evaluation of food procurement programs is required. Implementation of healthy food procurement policies in schools, worksites, hospitals, care homes, correctional facilities, government institutions, and remote communities increase markers of healthy eating. Prior or simultaneous implementation of ancillary education about healthy eating, and rationale for the policy may be critical success factors and additional research is needed. PMID:24595213
Mina Nicole Händel
Full Text Available There is limited evidence to support the effectiveness of primary interventions aiming to prevent excess weight gain among young children. Evaluating behavioral changes, such as physical activity (PA, may add to future development of efficient interventions. The objective was to evaluate the effect on PA outcomes of the 15 month Healthy Start intervention that focused on changing diet, PA, sleep and stress management among normal weight but obesity-prone preschool children. Children were defined as obesity-prone if they had a birth weight > 4,000 g, mothers with a pre-pregnancy body mass index of > 28 kg/m2, or mothers with ≤ 10 years of schooling.From a baseline study population of 635 normal weight 2-6 year old preschool children from the greater Copenhagen area, parents of 307 children had given information on PA at both the baseline and follow-up examinations. PA was obtained from a 7 days recording in the Children's Physical Activity Questionnaire. Time used for sport activities were combined with outdoor playing time to achieve a proxy of total PA level of moderate to vigorous intensity.Linear regression analyses revealed that at follow-up the intervention group spent more time on sports and outdoor activities combined per week than the control group (ITT analyses: intervention: 400 min/week; 95% confidence interval (CI: 341, 459 versus control: 321 min/week; 95% CI: 277, 366; p = 0.02, although no significant intervention effects were seen for each of the subcategories, e.g. sports participation, outdoor activities, screen time, or commuting frequency.Our results suggest that the overall time spent on sports and outdoor activities combined was increased at follow-up among normal weight obesity-prone children, as a result of the Healthy Start intervention.ClinicalTrials.gov NCT01583335.
Händel, Mina Nicole; Larsen, Sofus Christian; Rohde, Jeanett Friis; Stougaard, Maria; Olsen, Nanna Julie; Heitmann, Berit Lilienthal
There is limited evidence to support the effectiveness of primary interventions aiming to prevent excess weight gain among young children. Evaluating behavioral changes, such as physical activity (PA), may add to future development of efficient interventions. The objective was to evaluate the effect on PA outcomes of the 15 month Healthy Start intervention that focused on changing diet, PA, sleep and stress management among normal weight but obesity-prone preschool children. Children were defined as obesity-prone if they had a birth weight > 4,000 g, mothers with a pre-pregnancy body mass index of > 28 kg/m2, or mothers with ≤ 10 years of schooling. From a baseline study population of 635 normal weight 2-6 year old preschool children from the greater Copenhagen area, parents of 307 children had given information on PA at both the baseline and follow-up examinations. PA was obtained from a 7 days recording in the Children's Physical Activity Questionnaire. Time used for sport activities were combined with outdoor playing time to achieve a proxy of total PA level of moderate to vigorous intensity. Linear regression analyses revealed that at follow-up the intervention group spent more time on sports and outdoor activities combined per week than the control group (ITT analyses: intervention: 400 min/week; 95% confidence interval (CI): 341, 459 versus control: 321 min/week; 95% CI: 277, 366; p = 0.02), although no significant intervention effects were seen for each of the subcategories, e.g. sports participation, outdoor activities, screen time, or commuting frequency. Our results suggest that the overall time spent on sports and outdoor activities combined was increased at follow-up among normal weight obesity-prone children, as a result of the Healthy Start intervention. ClinicalTrials.gov NCT01583335.
Talati, Zenobia; Norman, Richard; Pettigrew, Simone; Neal, Bruce; Kelly, Bridget; Dixon, Helen; Ball, Kylie; Miller, Caroline; Shilton, Trevor
This study examined how front-of-pack labels and product healthfulness affect choice and willingness to pay across a range of foods. It was hypothesized that: (i) product choice and (ii) willingness to pay would be more aligned with product healthfulness when healthfulness was expressed through the Health Star Rating, followed by the Multiple Traffic Light, then the Daily Intake Guide, and (iii) the Nutrition Facts Panel would be viewed infrequently. Adults and children aged 10+ years (n = 2069) completed an online discrete choice task involving mock food packages. A 4 food type (cookies, corn flakes, pizza, yoghurt) × 2 front-of-pack label presence (present, absent) × 3 front-of-pack label type (Daily Intake Guide, Multiple Traffic Light, Health Star Rating) × 3 price (cheap, moderate, expensive) × 3 healthfulness (less healthy, moderately healthy, healthier) design was used. A 30 s time limit was imposed for each choice. Of the three front-of-pack labels tested, the Health Star Rating produced the largest differences in choices, with 40% (95% CIs: 38%-42%) of respondents selecting the healthier variant, 33% selecting the moderately healthy variant (95% CIs: 31%-35%), and 23% (95% CIs: 21%-24%) selecting the less healthy variant of the four products included in the study. The Multiple Traffic Light led to significant differences in choices between healthier (35%, 95% CIs: 33%-37%) and less healthy products (29%, 95% CIs: 27%-31%), but not moderately healthy products (32%, 95% CIs: 30%-34%). No significant differences in choices were observed by product healthfulness when the Daily Intake Guide was present. Only the Health Star Rating resulted in a significantly greater willingness to pay for healthier versus less healthy products. The Nutrition Facts Panel was viewed for only 7% of all mock packages. Front-of-pack labels that are more interpretive, such as the Health Star Rating, can be more effective at directing consumers towards healthier choices than
Full Text Available Intertemporal choices - involving decisions which trade off instant and delayed outcomes - are often made under stress. It remains unknown, however, whether and how stress affects intertemporal choice. We subjected 142 healthy male subjects to a laboratory stress or control protocol, and asked them to make a series of intertemporal choices either directly after stress, or 20 minutes later (resulting in four experimental groups. Based on theory and evidence from behavioral economics and cellular neuroscience, we predicted a bidirectional effect of stress on intertemporal choice, with increases in impatience or present bias immediately after stress, but decreases in present bias or impatience when subjects are tested 20 minutes later. However, our results show no effects of stress on intertemporal choice at either time point, and individual differences in stress reactivity (changes in stress hormone levels over time are not related to individual differences in intertemporal choice. Together, we did not find support for the hypothesis that psychosocial laboratory stressors affect intertemporal choice.
Williams, Christopher M; Nathan, Nicole; Delaney, Tessa; Yoong, Sze Lin; Wiggers, John; Preece, Sarah; Lubans, Nicole; Sutherland, Rachel; Pinfold, Jessica; Smith, Kay; Small, Tameka; Reilly, Kathryn L; Butler, Peter; Wyse, Rebecca J; Wolfenden, Luke
Introduction A number of jurisdictions internationally have policies requiring schools to implement healthy canteens. However, many schools have not implemented such policies. One reason for this is that current support interventions cannot feasibly be delivered to large numbers of schools. A promising solution to support population-wide implementation of healthy canteen practices is audit and feedback. The effectiveness of this strategy has, however, not previously been assessed in school canteens. This study aims to assess the effectiveness and cost-effectiveness of an audit and feedback intervention, delivered by telephone and email, in increasing the number of school canteens that have menus complying with a government healthy-canteen policy. Methods and analysis Seventy-two schools, across the Hunter New England Local Health District in New South Wales Australia, will be randomised to receive the multicomponent audit and feedback implementation intervention or usual support. The intervention will consist of between two and four canteen menu audits over 12 months. Each menu audit will be followed by two modes of feedback: a written feedback report and a verbal feedback/support via telephone. Primary outcomes, assessed by dieticians blind to group status and as recommended by the Fresh Tastes @ School policy, are: (1) the proportion of schools with a canteen menu containing foods or beverages restricted for sale, and; (2) the proportion of schools that have a menu which contains more than 50% of foods classified as healthy canteen items. Secondary outcomes are: the proportion of menu items in each category (‘red’, ‘amber’ and ‘green’), canteen profitability and cost-effectiveness. Ethics and dissemination Ethical approval has been obtained by from the Hunter New England Human Research Ethics Committee and the University of Newcastle Human Research Ethics Committee. The findings will be disseminated in usual forums, including peer
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Albert, Nancy M; Butler, Robert; Sorrell, Jeanne
Hospitals often promote healthy lifestyles, but little is known about nurses' actual diet and physical activity. Greater understanding about these lifestyle choices for clinical nurses may improve existing hospital-based programs and/or create desirable services. This article discusses a study that considered diet and physical activity of clinical nurses, using elements of Pender's self-care theory as a conceptual framework. Study methods included a cross-sectional, correlational design and a convenience sample of 278 nurses who worked on units with 24 hours/day and seven days-per-week responsibilities. Participants completed diet and exercise questionnaires about perceptions of attitudes and opinions, barriers, diet benefits/exercise motivators, self-efficacy, and locus of control, and personal and work characteristics. Diet and activity categories were created. Study results demonstrated that over 50% of nurses had moderately healthy diets but were insufficiently active. Healthy diet and physical activity levels were associated with higher self-efficacy, more diet benefits and physical activity motivators, fewer perceived barriers, and confidence in body image. The article discussion and conclusion sections note areas for future research and suggest that focused interventions that address benefits, motivators, and self-efficacy may increase participation in hospital-based programs and enhance healthy lifestyle for hospital-based clinical nurses.
McPhail-Bell, Karen; Appo, Nathan; Haymes, Alana; Bond, Chelsea; Brough, Mark; Fredericks, Bronwyn
The potential for health promotion through social networking sites (SNSs) is widely recognized. However, while health promotion prides itself in focusing on the social determinants of health, its partiality for persuading individuals to comply with health behaviours dominates the way health promotion utilizes SNSs. This paper contributes to an understanding of collaborative ways SNSs can work for health promotion agendas of self-determination and empowerment in an Indigenous Australia context. An ethnographic study was undertaken with Deadly Choices, an Indigenous-led health promotion initiative. The study involved participant observation of interactions on Deadly Choices SNSs between Deadly Choices and its online community members. Deadly Choices provides an example of SNSs providing a powerful tool to create a safe, inclusive and positive space for Indigenous people and communities to profile their healthy choices, according to Indigenous notions of health and identity. The study found five principles that underpin Deadly Choices' use of SNSs for health promotion. These are: create a dialogue; build community online and offline; incentivise healthy online engagement; celebrate Indigenous identity and culture; and prioritize partnerships. Deadly Choices SNSs empowers Indigenous people and communities to be health promoters themselves, which represents a power shift from health promotion practitioner to Indigenous people and communities and more broadly, an enactment of Indigenous self-determination on SNSs. Mainstream health promotion can learn from Indigenous health promotion practice regarding the use of SNSs for health promotion agendas. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Koo, H C; Poh, B K; Ruzita, Abd Talib
The rapid increase in childhood obesity is a serious public health problem, and has led to the development of many interventions. However, no intervention has emphasized whole grains as a strategy to manage childhood obesity. Therefore, this article describes the protocol of a 12-week multi-component, family-based intervention on whole grain, using a healthy balanced diet for managing childhood obesity. The GReat-Child trial utilize a quasi-experimental method in which two schools in Kuala Lumpur are assigned to intervention and control groups. The eligibility criteria are overweight/obese children, aged 9 through 11 years, who has no serious co-morbidities. The children who report consuming whole-grain foods in their 3-day diet-recall during the screening will be excluded. The study sample is characterized by anthropometric measurements (weight, height, percentage of body fat and waist circumference), whole grain and nutrient intakes (3-day 24-h diet recalls), and their knowledge, attitudes and practices towards whole grain. The 12-week intervention is comprised of three components addressing behaviour, personal and environmental factors, based on social cognitive theory: (1) individual diet counselling for the parents; (2) six 30-min nutrition education classes and (3) school delivery of whole-grain foods; The control school does not receive any interventions, however, for ethical purposes, a health talk is conducted after the entire GReat-Child Trial is completed. The GReat-Child trial represents a novel approach to examining the effectiveness of the intervention of whole grain in a healthy balanced diet on managing childhood obesity. We anticipate that this trial will reveal not only whether whole grain intervention will be effective in managing childhood obesity, but also provide greater insights into the acceptance of whole grain among Malaysian children.
Robinson, Eric; Blissett, Jackie; Higgs, Suzanne
Novel ways to increase liking and intake of food are needed to encourage acceptance of healthier food. How enjoyable we remember food to have been is likely to be a significant predictor of food choice. Two studies examined whether remembered enjoyment of eating a food can be increased and whether this makes individuals more likely to eat that food in the future. In Study One, a simple manipulation of instructing participants to rehearse what they found enjoyable about a food immediately after eating it was used to increase remembered enjoyment (relative to controls). In a separate study; Study Two, the effect of increasing remembered enjoyment on food choice was tested by examining whether the manipulation to increase remembered enjoyment resulted in participants choosing to eat more of a food as part of a later buffet lunch. The experimental manipulation increased remembered enjoyment for the food (Study One). A change in remembered enjoyment was shown to have a significant effect on the amount of a food participants chose to eat the following day for lunch (Study Two). The present studies suggest that remembered enjoyment can be increased via a simple act of rehearsal, resulting in a later increase in the amount of food chosen and eaten. Interventions based on altering remembered enjoyment of healthy food choices warrant further investigation.
Mary Jane Brown
Full Text Available BACKGROUND: Excess gestational weight gain (GWG is an important risk factor for long term obesity in women. However, current interventions aimed at preventing excess GWG appear to have a limited effect. Several studies have highlighted the importance of linking theory with empirical evidence for producing effective interventions for behaviour change. Theorists have demonstrated that goals can be an important source of human motivation and goal setting has shown promise in promoting diet and physical activity behaviour change within non-pregnant individuals. The use of goal setting as a behaviour change strategy has been systematically evaluated within overweight and obese individuals, yet its use within pregnancy has not yet been systematically explored. AIM OF REVIEW: To explore the use of goal setting within healthy lifestyle interventions for the prevention of excess GWG. DATA COLLECTION AND ANALYSIS: Searches were conducted in seven databases alongside hand searching of relevant journals and citation tracking. Studies were included if interventions used goal setting alongside modification of diet and/or physical activity with an aim to prevent excess GWG. The PRISMA guidelines were followed and a two-stage methodological approach was used. Stage one focused on systematically evaluating the methodological quality of included interventions. The second stage assessed intervention integrity and the implementation of key goal setting components. FINDINGS: From a total of 839 citations, 54 full-text articles were assessed for eligibility and 5 studies met the inclusion criteria. Among interventions reporting positive results a combination of individualised diet and physical activity goals, self-monitoring and performance feedback indicators were described as active components. CONCLUSION: Interventions based on goal setting appear to be useful for helping women achieve optimal weight gain during pregnancy. However, overweight and obese women may
Brown, Mary Jane; Sinclair, Marlene; Liddle, Dianne; Hill, Alyson J; Madden, Elaine; Stockdale, Janine
Excess gestational weight gain (GWG) is an important risk factor for long term obesity in women. However, current interventions aimed at preventing excess GWG appear to have a limited effect. Several studies have highlighted the importance of linking theory with empirical evidence for producing effective interventions for behaviour change. Theorists have demonstrated that goals can be an important source of human motivation and goal setting has shown promise in promoting diet and physical activity behaviour change within non-pregnant individuals. The use of goal setting as a behaviour change strategy has been systematically evaluated within overweight and obese individuals, yet its use within pregnancy has not yet been systematically explored. To explore the use of goal setting within healthy lifestyle interventions for the prevention of excess GWG. Searches were conducted in seven databases alongside hand searching of relevant journals and citation tracking. Studies were included if interventions used goal setting alongside modification of diet and/or physical activity with an aim to prevent excess GWG. The PRISMA guidelines were followed and a two-stage methodological approach was used. Stage one focused on systematically evaluating the methodological quality of included interventions. The second stage assessed intervention integrity and the implementation of key goal setting components. From a total of 839 citations, 54 full-text articles were assessed for eligibility and 5 studies met the inclusion criteria. Among interventions reporting positive results a combination of individualised diet and physical activity goals, self-monitoring and performance feedback indicators were described as active components. Interventions based on goal setting appear to be useful for helping women achieve optimal weight gain during pregnancy. However, overweight and obese women may require more theoretically-designed interventions. Further high quality, theoretically
Wright, Stuart J; Gibson, Debbie; Eden, Martin; Lal, Simon; Todd, Chris; Ness, Andy; Burden, Sorrel
Studies on healthy lifestyle interventions in survivors of colorectal cancer have been disappointing, demonstrating only modest changes. This study aims to quantify people's preferences for different aspects of dietary intervention. A best-worst discrete choice experiment was designed and incorporated into a questionnaire including participants' characteristics and a self-assessment of lifestyle. The response rate was 68% and 179 questionnaires were analysed. When analysing aggregate preferences, the modes of information provision selected as the most preferred were "face-to-face" (willingness to pay (WTP) £63.97, p ≤ 0.001) and "telephone" (WTP £62.36, p WTP -£118.96, p ≤ 0.001). Scenarios that included hospitals were most preferred (WTP £17.94, p = 0.031), and the favoured provider was bowel cancer nurses (WTP £75.11, p ≤ 0.001). When investigating preference heterogeneity, three sub-groups were identified: Firstly, "technophiles" preferring email (WTP £239.60, p ≤ 0.001) were male, were younger and had fewer risk factors. Secondly, a "one-to-one" group had strong preference for interventions over the telephone or at their local doctors and were older (WTP £642.13, p ≤ 0.001). Finally, a "person-centred" group preferred face-to-face individual or group sessions (WTP £358.79, p < 0.001) and had a high risk lifestyle. For survivors of colorectal cancer, there is not one approach that suits all when it comes to providing dietary advice. This is important information to consider when planning healthy lifestyle interventions which include dietary advice for survivors of colorectal cancer. Aligning services to individuals' preferences has the potential to improve patient experience and outcomes by increasing uptake of healthy lifestyle advice services and promoting a more tailored approach to dietary modifications, acknowledging sub-groups of people within the total population of colorectal cancer survivors.
Billich, Natassja; Adderley, Marijke; Ford, Laura; Keeton, Isabel; Palermo, Claire; Peeters, Anna; Woods, Julie; Backholer, Kathryn
School canteens have an important role in modelling a healthy food environment. Price is a strong predictor of food and beverage choice. This study compared the relative price of healthy and less healthy lunch and snack items sold within Australian school canteens. A convenience sample of online canteen menus from five Australian states were selected (100 primary and 100 secondary schools). State-specific canteen guidelines were used to classify menu items into 'green' (eat most), 'amber' (select carefully) and 'red' (not recommended in schools). The price of the cheapest 'healthy' lunch (vegetable-based 'green') and snack ('green' fruit) item was compared to the cheapest 'less healthy' ('amber/red') lunch and snack item, respectively, using an un-paired t-test. The relative price of the 'healthy' items and the 'less healthy' items was calculated to determine the proportion of schools that sold the 'less healthy' item cheaper. The mean cost of the 'healthy' lunch items was greater than the 'less healthy' lunch items for both primary (AUD $0.70 greater) and secondary schools ($0.50 greater; p snack was cheaper than the 'healthy' snack. These proportions were greatest for primary schools located in more, compared to less, disadvantaged areas. The relative price of foods sold within Australian school canteens appears to favour less healthy foods. School canteen healthy food policies should consider the price of foods sold.
Friedl, Karl E; Rowe, Sylvia; Bellows, Laura L; Johnson, Susan L; Hetherington, Marion M; de Froidmont-Görtz, Isabelle; Lammens, Veerle; Hubbard, Van S
This report summarizes an EU-US Task Force on Biotechnology Research symposium on healthy food choices and nutrition-related purchasing behaviors. This meeting was unique in its transdisciplinary approach to obesity and in bringing together scientists from academia, government, and industry. Discussion relevant to funders and researchers centered on (1) increased use of public-private partnerships, (2) the complexity of food behaviors and obesity risk and multilevel aspects that must be considered, and (3) the importance of transatlantic cooperation and collaboration that could accelerate advances in this field. A call to action stressed these points along with a commitment to enhanced communication strategies. Copyright © 2014 Society for Nutrition Education and Behavior. All rights reserved.
Jacey A. Greece
Full Text Available Modifying the school food environment is on the national agenda as one strategy to improve the nutritional quality of children’s diets. Because few environmental-level interventions have been rigorously evaluated, the evidence base to inform programs and policies is limited. Of concern is the impact that changes to cafeteria offerings will have on participation in school meal programs. This study evaluates school lunch participation in the setting of a year-long middle school cafeteria intervention by examining the association between body mass index (BMI, sociodemographics, and the purchases of school lunch meals. IMOVE meals were healthier choices that met stringent nutritional criteria and were offered alongside standard lunch meals. Students who were overweight had a significantly higher purchase rate for both types of meals compared to those with a healthy BMI. Non-white race, younger age, being male, and low-income status were also significantly associated with participation in school lunch. Results indicate that nutritionally vulnerable students participate in school lunch and are equally likely to buy healthy alternatives or standard meals. This behavioral observation has important implications for school foodservice programs and policies. These results are timely given recent federal legislation to improve the school food environment to influence students’ food choice behaviors.
Greece, Jacey A; Kratze, Alyssa; DeJong, William; Cozier, Yvette C; Quatromoni, Paula A
Modifying the school food environment is on the national agenda as one strategy to improve the nutritional quality of children's diets. Because few environmental-level interventions have been rigorously evaluated, the evidence base to inform programs and policies is limited. Of concern is the impact that changes to cafeteria offerings will have on participation in school meal programs. This study evaluates school lunch participation in the setting of a year-long middle school cafeteria intervention by examining the association between body mass index (BMI), sociodemographics, and the purchases of school lunch meals. IMOVE meals were healthier choices that met stringent nutritional criteria and were offered alongside standard lunch meals. Students who were overweight had a significantly higher purchase rate for both types of meals compared to those with a healthy BMI. Non-white race, younger age, being male, and low-income status were also significantly associated with participation in school lunch. Results indicate that nutritionally vulnerable students participate in school lunch and are equally likely to buy healthy alternatives or standard meals. This behavioral observation has important implications for school foodservice programs and policies. These results are timely given recent federal legislation to improve the school food environment to influence students' food choice behaviors.
Sarah T. Stahl
Discussion: Several challenges in implementing our lifestyle interventions to older widow(ers who are at risk for common mental disorders have been identified. Direct outreach to hospice organizations is an effective way to identify older adults in the early months following spousal death. Results from study may advance the field of grief support and promote a healthy adaptation to widowhood.
Nordström, Jonas; Thunström, Linda
Food high in energy but low in nutritional value is an important contributor to several serious illnesses, and one type of food that is particularly high in energy but low in nutrition is food consumed away from home. In this paper, we examine the demand and willingness to pay for healthy, Keyhole-labelled meals. A Keyhole-labelled meal is particularly low in energy, fat, sugar and salt, but particularly high in fibre. The results suggest that to get the majority of individuals to choose the healthy option regularly it would be necessary to alter the relative price between healthy and less healthy meals. Generally groups of individuals with a poor nutritional intake require a larger compensation (subsidy) before they choose the healthy alternative. About one third of respondents would choose the healthy option regularly if the prices for a healthy and less healthy meal were the same. In particular groups of individuals who already have a relatively good nutritional intake would select the healthy option. Groups with a generally poor nutritional intake (men and individuals with lower education and lower income) would gain health benefits from a subsidy of Keyhole-labelled meals. Copyright © 2015 Elsevier Ltd. All rights reserved.
Van Wezemael, Lynn; Verbeke, Wim; Dutra de Barcellos, Marcia
of beef consumed. Focus group participants were not in favour of improving beef healthiness during processing, but rather focussed on appropriate consumption behaviour and preparation methods. CONCLUSIONS: The individual responsibility for health implies that consumers should be able to make correct......BACKGROUND: Consumer perception of the healthiness of beef is an important determinant of beef consumption. However, little is known about how consumers perceive the healthiness of beef. The aim of this study is to shed light on the associations between beef and health. METHODS: Eight focus group...... as well as negative effects of beef consumption on their health. Labelled, branded, fresh and lean beef were perceived as signalling healthful beef, in contrast with further processed and packaged beef. Consumers felt that their individual choices could make a difference with respect to the healthiness...
Food choices and diet composition have been studied less often than energy intake in subjects with varying levels of physical activity. The reported effects of exercise on food choices are not fully consistent, especially on the short term. Type of exercise, intensity, duration can affect the results as well as subjects' characteristics (gender, age, previous training and fitness). A crucial role could also be played by psychological (chronic dieting, attitudes toward health and food, long-established food habits and preferences) and social (traditions, food availability, appropriate times and places) factors. In short-term intervention studies, where a meal is ingested a few minutes following a bout of exercise of varying duration and intensity, an increase in CHO intake is most often reported, while increased protein intake is an occasional observation. In long-term (several weeks) training interventions, intake is assessed from dietary records. Again CHO intake is augmented in exercised subjects as compared to controls, while that of saturated fats and cholesterol may also be affected. Epidemiological studies (without dietary or exercise intervention) often report that habitually active persons eat more and ingest more fruits and vegetables than less active peers. It is not known to what extent such food choices are driven by biological needs (e.g. replacement of glycogen) or elicited by social and psychological factors.
Taylor, Natalie J; Sahota, Pinki; Sargent, Judith; Barber, Sally; Loach, Jackie; Louch, Gemma; Wright, John
Interventions that make extensive use of theory tend to have larger effects on behaviour. The Intervention Mapping (IM) framework incorporates theory into intervention design, implementation and evaluation, and was applied to the development of a community-based childhood obesity prevention intervention for a multi-ethnic population. IM was applied as follows: 1) Needs assessment of the community and culture; consideration of evidence-base, policy and practice; 2) Identification of desired outcomes and change objectives following identification of barriers to behaviour change mapped alongside psychological determinants (e.g. knowledge, self-efficacy, intention); 3) Selection of theory-based methods and practical applications to address barriers to behaviour change (e.g., strategies for responsive feeding); 4) Design of the intervention by developing evidence-based interactive activities and resources (e.g., visual aids to show babies stomach size). The activities were integrated into an existing parenting programme; 5) Adoption and implementation: parenting practitioners were trained by healthcare professionals to deliver the programme within Children Centres. HAPPY (Healthy and Active Parenting Programme for Early Years) is aimed at overweight and obese pregnant women (BMI > 25); consists of 12 × 2.5 hr. sessions (6 ante-natal from 24 weeks; 6 postnatal up to 9 months); it addresses mother's diet and physical activity, breast or bottle feeding, infant diet and parental feeding practices, and infant physical activity. We have demonstrated that IM is a feasible and helpful method for providing an evidence based and theoretical structure to a complex health behaviour change intervention. The next stage will be to assess the impact of the intervention on behaviour change and clinical factors associated with childhood obesity. The HAPPY programme is currently being tested as part of a randomised controlled feasibility trial.
Wong, Michelle S; Nau, Claudia; Kharmats, Anna Yevgenyevna; Vedovato, Gabriela Milhassi; Cheskin, Lawrence J; Gittelsohn, Joel; Lee, Bruce Y
Product placement influences consumer choices in retail stores. While sugar sweetened beverage (SSB) manufacturers expend considerable effort and resources to determine how product placement may increase SSB purchases, the information is proprietary and not available to the public health and research community. This study aims to quantify the effect of non-SSB product placement in corner stores on adolescent beverage purchasing behavior. Corner stores are small privately owned retail stores that are important beverage providers in low-income neighborhoods--where adolescents have higher rates of obesity. Using data from a community-based survey in Baltimore and parameters from the marketing literature, we developed a decision-analytic model to simulate and quantify how placement of healthy beverage (placement in beverage cooler closest to entrance, distance from back of the store, and vertical placement within each cooler) affects the probability of adolescents purchasing non-SSBs. In our simulation, non-SSB purchases were 2.8 times higher when placed in the "optimal location"--on the second or third shelves of the front cooler--compared to the worst location on the bottom shelf of the cooler farthest from the entrance. Based on our model results and survey data, we project that moving non-SSBs from the worst to the optional location would result in approximately 5.2 million more non-SSBs purchased by Baltimore adolescents annually. Our study is the first to quantify the potential impact of changing placement of beverages in corner stores. Our findings suggest that this could be a low-cost, yet impactful strategy to nudge this population--highly susceptible to obesity--towards healthier beverage decisions.
Christensen, Emily Fast
The purpose of this research was to test an intervention of choices in homework on the achievement and intrinsic motivation of seventh-grade science students at a middle school. The intervention was based on concepts from the cognitive evaluation theory of Edward L. Deci and Richard M. Ryan (1985). The subjects were sixteen heterogeneous classes of seventh-grade students, who were divided among four teachers. Two randomly chosen classes from each teacher received choices in their homework and the remaining two classes of each teacher received similar homework assignments without choices. Two hypotheses were developed for this study: (1) Seventh-grade science students given choices in their homework would show an increase in intrinsic motivation as measured on a motivation orientation measure, compared to students not given choices in their homework, and (2) Seventh-grade science students given choices in their homework would show an increase in achievement on an achievement measure, compared to students not given choices in their homework. Having choices in homework did not increase intrinsic motivation or achievement. However, students who did their homework did significantly better on the posttest, and students who were more intrinsically motivated did significantly better on the posttest. Just doing the homework was important for achievement, and intrinsic motivation was linked to achievement.
Hannan, Peter J; Harnack, Lisa J; Mitchell, Nathan R; Toomey, Traci L; Gerlach, Anne
Objective To evaluate the effects of lowering prices and increasing availability on sales of healthy foods and beverages from 33 vending machines in four bus garages as part of a multi-component worksite obesity prevention intervention. Methods Availability of healthy items was increased to 50% and prices were lowered at least 10% in the vending machines in two metropolitan bus garages for an 18-month period. Two control garages offered vending choices at usual availability and prices. Sales data were collected monthly from each of the vending machines at the four garages. Results Increases in availability to 50% and price reductions of an average of 31% resulted in 10-42% higher sales of the healthy items. Employees were most price-responsive for snack purchases. Conclusions Greater availability and lower prices on targeted food and beverage items from vending machines was associated with greater purchases of these items over an eighteen-month period. Efforts to promote healthful food purchases in worksite settings should incorporate these two strategies. PMID:20061884
The effect of an online video intervention 'Movie Models' on specific parenting practices and parental self-efficacy related to children's physical activity, screen-time and healthy diet: a quasi experimental study.
De Lepeleere, Sara; De Bourdeaudhuij, Ilse; Cardon, Greet; Verloigne, Maïté
In children, being sufficiently physically active, having low levels of screen-time and having a healthy diet are largely influenced by parenting practices. Children of parents applying positive parenting practices are at lower risk for overweight and obesity. Therefore, we investigated the effect of a health promoting online video intervention for parents ('Movie Models') on children's physical activity (PA), screen-time and healthy diet, and on specific parenting practices and parental self-efficacy related to these parenting practices. The online videos are delivered to parents of primary schoolchildren, and were based on real-life scenarios. A two-armed, quasi experimental design was used. Parents of primary schoolchildren were recruited between November and December 2013 by spreading an appeal in social media, and by contacting primary schools. Participating parents were predominantly of high socio-economic status (SES) (83.1%), and only 6.8% of children were overweight/obese. Intervention group participants were invited to watch online videos for 4 weeks. Specific parenting practices, parental self-efficacy, PA, screen-time and healthy diet of the child were assessed at baseline (T0), at one (T1) and at four (T2) months post baseline. Repeated Measures (Multivariate) ANOVAs were used to examine intervention effects. The potential moderating effect of age and gender of the child and parental SES was also examined. Between T0 and T2, no significant intervention effects were found on children's PA, screen-time or healthy diet. Most significant intervention effects were found for more complex parenting practices (e.g., an increase in motivating the child to eat fruit). Subgroup analyses showed that the intervention had more effect on the actual parenting practices related to PA, screen-time and healthy diet in parents of older children (10-12 years old), whereas intervention effects on parental self-efficacy related to those behaviors were stronger in parents of
Mobley, Connie C.; Stadler, Diane D.; Staten, Myrlene A.; El Ghormli, Laure; Gillis, Bonnie; Hartstein, Jill; Siega-Riz, Anna Maria; Virus, Amy
Background: The HEALTHY primary prevention trial developed an integrated multicomponent intervention program to moderate risk factors for type 2 diabetes in middle schools. The nutrition component aimed to improve the quality of foods and beverages served to students. Changes in the School Breakfast Program (SBP), National School Lunch Program…
Petit, Olivia; Merunka, Dwight; Anton, Jean-Luc; Nazarian, Bruno; Spence, Charles; Cheok, Adrian David; Raccah, Denis; Oullier, Olivier
Taking into account how people value the healthiness and tastiness of food at both the behavioral and brain levels may help to better understand and address overweight and obesity-related issues. Here, we investigate whether brain activity in those areas involved in self-control may increase significantly when individuals with a high body-mass index (BMI) focus their attention on the taste rather than on the health benefits related to healthy food choices. Under such conditions, BMI is positively correlated with both the neural responses to healthy food choices in those brain areas associated with gustation (insula), reward value (orbitofrontal cortex), and self-control (inferior frontal gyrus), and with the percent of healthy food choices. By contrast, when attention is directed towards health benefits, BMI is negatively correlated with neural activity in gustatory and reward-related brain areas (insula, inferior frontal operculum). Taken together, these findings suggest that those individuals with a high BMI do not necessarily have reduced capacities for self-control but that they may be facilitated by external cues that direct their attention toward the tastiness of healthy food. Thus, promoting the taste of healthy food in communication campaigns and/or food packaging may lead to more successful self-control and healthy food behaviors for consumers with a higher BMI, an issue which needs to be further researched. PMID:27428267
Fraticelli, Federica; Marchetti, Daniela; Polcini, Francesco; Mohn, Angelika Anna; Chiarelli, Francesco; Fulcheri, Mario; Vitacolonna, Ester
Healthy lifestyle promotion programs are essential to prevent metabolic diseases such as obesity and diabetes. Adolescents could represent the ideal target population especially using serious web games. To test the improvement of knowledge about healthy nutrition in adolescents and to analyze participants' enjoyment in playing the web game "Gustavo in Gnam's Planet" in comparison with a leisure web game. Sixty-five adolescents were engaged in three supervised group sessions. Measures about healthy food knowledge and games' enjoyment were collected during the three stages of assessment. After playing Gustavo in Gnam's Planet, participants significantly improved their knowledge on a healthy diet, compared to the recreational web games; whereas the level of fun experienced while playing the recreational and the educational games was not significantly different. Gustavo in Gnam's Planet is an important promising tool, with entertainment property, to promote a healthy lifestyle in Italian adolescents.
Lee, Chia-Kuei; Liao, Li-Ling; Lai, I-Ju; Chang, Li-Chun
Unhealthy eating behaviors contribute to obesity and chronic illness. This study examined the relative contributions of a healthy-eater self-schema (a self-conception as a healthy eater) and nutrition literacy on healthy-eating behaviors and whether nutrition literacy was a mediator among Taiwanese college students. A total of 1216 undergraduate students from six universities in Taiwan participated in the study from April to June 2016. Healthy-eating behaviors, nutrition literacy, healthy-eater self-schema and known determinants of eating behaviors (e.g. nutrition-related information, health status, nutrition knowledge needs, sex, year in college and residence) were measured by a self-report questionnaire. A hierarchical multiple regression and mediation analysis were conducted with the known determinants of eating behaviors as covariates. Results showed that a healthy-eater self-schema and nutrition literacy explained 9% and 12% of the variance in healthy-eating behaviors, respectively, and both had unique effects on healthy-eating behaviors. The effect of a healthy-eater self-schema on healthy-eating behaviors was partially mediated through nutrition literacy. Findings suggest that both a healthy-eater self-schema and nutrition literacy should be considered when promoting healthy-eating behaviors. Additionally, nutrition literacy interventions should be tailored to the healthy-eater self-schema status and emphasize the personal relevance of being a healthy-eater to improve the intervention's effectiveness. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
Lankinen, Maria; Schwab, Ursula; Kolehmainen, Marjukka; Paananen, Jussi; Nygren, Heli; Seppänen-Laakso, Tuulikki; Poutanen, Kaisa; Hyötyläinen, Tuulia; Risérus, Ulf; Savolainen, Markku J; Hukkanen, Janne; Brader, Lea; Marklund, Matti; Rosqvist, Fredrik; Hermansen, Kjeld; Cloetens, Lieselotte; Önning, Gunilla; Thorsdottir, Inga; Gunnarsdottir, Ingibjorg; Åkesson, Björn; Dragsted, Lars Ove; Uusitupa, Matti; Orešič, Matej
A healthy Nordic diet is associated with improvements in cardiometabolic risk factors, but the effect on lipidomic profile is not known. The aim was to investigate how a healthy Nordic diet affects the fasting plasma lipidomic profile in subjects with metabolic syndrome. Men and women (n = 200) with features of metabolic syndrome [mean age: 55 y; body mass index (in kg/m 2 ): 31.6] were randomly assigned to either a healthy Nordic (n = 104) or a control (n = 96) diet for 18 or 24 wk at 6 centers. Of the participants, 156 completed the study with plasma lipidomic measurements. The healthy Nordic diet consisted of whole grains, fruits, vegetables, berries, vegetable oils and margarines, fish, low-fat milk products, and low-fat meat. An average Nordic diet served as the control diet and included low-fiber cereal products, dairy fat-based spreads, regular-fat milk products, and a limited amount of fruits, vegetables, and berries. Lipidomic profiles were measured at baseline, week 12, and the end of the intervention (18 or 24 wk) by using ultraperformance liquid chromatography mass spectrometry. The effects of the diets on the lipid variables were analyzed with linear mixed-effects models. Data from centers with 18- or 24-wk duration were also analyzed separately. Changes in 21 plasma lipids differed significantly between the groups at week 12 (false discovery rate P Nordic diet group compared with the control group. At the end of the study, changes in lipidomic profiles did not differ between the groups. However, when the intervention lasted 24 wk, changes in 8 plasma lipids that had been identified at 12 wk, including plasmalogens, were sustained. There were no differences in changes in plasma lipids between groups with an intervention of 18 wk. By the dietary biomarker score, adherence to diet did not explain the difference in the results related to the duration of the study. A healthy Nordic diet transiently modified the plasma lipidomic profile, specifically by
Bucher Tamara; Collins Clare; Rollo Megan E.; McCaffrey Tracy A.; De Vlieger Nienke; Van der Bend Daphne; Truby Helen; Perez-Cueto Federico J. A.
Nudging or 'choice architecture' refers to strategic changes in the environment that are anticipated to alter people's behaviour in a predictable way without forbidding any options or significantly changing their economic incentives. Nudging strategies may be used to promote healthy eating behaviour. However to date the scientific evidence has not been systematically reviewed to enable practitioners and policymakers to implement or argue for the implementation of specific measures to support ...
Maulida, Rizka; Nanishi, Keiko; Green, Joseph; Shibanuma, Akira; Jimba, Masamine
The aims of the present study were to assess the reliability and validity of the Food Choice Questionnaire (FCQ) and to determine the factors associated with food-choice motives in public junior-high-school students in Jakarta, Indonesia. Cross-sectional study with self-administered questionnaires. Trained research assistants measured height and weight of the participants on the day of the data collection. Settings Fourteen randomly selected public junior-high schools in East Jakarta, Indonesia. Public junior-high-school students (n 681) in grades 7 and 8, aged 13-14 years (377 girls and 304 boys). Three food-choice motives (subscales) were obtained from factor analysis and reliability testing: (i) comfort; (ii) convenience and price; and (iii) health. The subscale with the greatest mean value was health. Family affluence was inversely associated with the convenience and price subscale (β=-0·05, P=0·01) and with the health subscale (β=-0·04; P=0·02). Females were less likely than males to consider health when choosing foods (β=-0·16; P=0·03). While its factor structure differed from those found in previous studies of adults, the FCQ can provide reliable measures of food-choice motives among these adolescents. Students from less affluent families placed more importance on food's convenience and price, but more affluent students did not necessarily make healthier choices. Compared with females, males were more likely to choose healthy foods. Future interventions should be tailored based on the socio-economic status of the target group.
Willcox, Jane Catherine; Campbell, Karen Jane; McCarthy, Elizabeth Anne; Wilkinson, Shelley Ann; Lappas, Martha; Ball, Kylie; Fjeldsoe, Brianna; Griffiths, Anne; Whittaker, Robyn; Maddison, Ralph; Shub, Alexis; Pidd, Deborah; Fraser, Elise; Moshonas, Nelly; Crawford, David Andrew
Overweight, obesity and excess gestational weight gain (GWG) are associated with negative health outcomes for mother and child in pregnancy and across the life course. Interventions promoting GWG within guidelines report mixed results. Most are time and cost intensive, which limits scalability. Mobile technologies (mHealth) offer low cost, ready access and individually-tailored support. We aim to test the feasibility of an mHealth intervention promoting healthy nutrition, physical activity and GWG in women who begin pregnancy overweight or obese. txt4two is a parallel randomised control trial pilot recruiting women with a singleton, live gestation between 10(+0) and 17(+6) weeks at the first hospital antenatal clinic visit. Inclusion criteria are pre-pregnancy BMI > 25 kg/m(2) and mobile phone ownership. One hundred consenting women will be randomised to intervention or control groups at a 1:1 ratio. All participants will receive standard antenatal care. In addition, the txt4two intervention will be delivered from baseline to 36 weeks gestation and consists of a tailored suite of theoretically-grounded, evidence-based intervention strategies focusing on healthy nutrition, physical activity and GWG. This includes: mobile phone interactive text messages promoting positive health behaviours, goal setting and self-monitoring; video messages; an information website; and a private moderated Facebook® chat forum. The primary outcome is the feasibility of the intervention. Secondary outcomes include GWG and participants' knowledge and behaviour regarding diet and physical activity during pregnancy. Findings will inform the development of larger-scale mHealth programmes to improve the delivery of healthy pregnancy nutrition, physical activity and GWG, that could be widely translated and disseminated. Australian New Zealand Clinical Trials Registry: ACTRNU111111544397 . Date of registration: 19 March 2014.
Llauradó, Elisabet; Aceves-Martins, Magaly; Tarro, Lucia; Papell-Garcia, Ignasi; Puiggròs, Francesc; Arola, Lluís; Prades-Tena, Jordi; Montagut, Marta; Moragas-Fernández, Carlota M; Solà, Rosa; Giralt, Montse
The encouragement of healthy lifestyles for obesity prevention in young people is a public health priority. The European Youth Tackling Obesity (EYTO) project is a multicentric intervention project with participation from the United Kingdom, Portugal, the Czech Republic and Spain. The general aim of the EYTO project is to improve lifestyles, including nutritional habits and physical