A randomized trial of a brief intervention to increase fruit and vegetable intake: a replication study among callers to the CIS

Concomitant sensory stimulation during therapy to enhance hand functional recovery post stroke

Background

Post-stroke hand impairment is prevalent and persistent even after a full course of rehabilitation. Hand diminishes stroke survivors’ abilities for activities of daily living and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. Recently, a novel sensory stimulation, TheraBracelet, has been developed in which imperceptible vibration is applied during task practice through a wrist-worn device. The objective of this trial is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone.

Methods

A double-blind randomized controlled trial will be used. Chronic stroke survivors will undergo a standardized hand task practice therapy program (3 days/week for 6 weeks) while wearing a device on the paretic wrist. The device will deliver TheraBracelet vibration for the treatment group and no vibration for the control group. The primary outcome is hand function measured by the Wolf Motor Function Test. Other outcomes include the Box and Block Test, Action Research Arm Test, upper extremity use in daily living, biomechanical measure of the sensorimotor grip control, and EEG-based neural communication.

Discussion

This research will determine clinical utility of TheraBracelet to guide future translation. The TheraBracelet stimulation is delivered via a wrist-worn device, does not interfere with hand motion, and can be easily integrated into clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life and reduce caregiver burden.

Trial registration

NCT04569123. Registered on September 29, 2020

Food insecurity is associated with unhealthy dietary practices among US veterans in California

OBJECTIVE

US veterans (hereafter, 'veterans') are at risk for being overweight or obese and associated unhealthy behaviours, including poor diet; although limited studies have examined the underlying factors associated with such outcomes. As such, the present study evaluated the association between food insecurity and dietary practices among veterans.

DESIGN

A secondary analysis of cross-sectional data from the California Health Interview Survey (2009, 2011/2012) was conducted. Survey weights were applied to identify univariate means, population estimates and weighted percentages. Bivariate analyses followed by survey-weighted negative binomial regression were used to model the association between food insecurity and dietary practices of fruit, vegetable, fast food and soda intakes.

SETTING

California Health Interview Survey 2009-2011/2012.

SUBJECTS

The present study included a total of 11 011 veterans from California.

RESULTS

Nearly 5 % of the studied veteran population reported living in poverty with food insecurity. Compared with those at or above the poverty level and those in poverty but food secure, the mean intakes of fruits and vegetables were lower, while the mean intakes of soda and fast foods (P for trend <0·05) were higher among veterans living in poverty with food insecurity. Food insecurity was associated with 24 and 142 % higher average consumption of fast foods and soda, respectively, and 24 % lower fruit intake.

CONCLUSIONS

Food insecurity remains a burden among veterans and is associated with unhealthy dietary practices. Targeted interventions to improve diet quality are imperative.

Association of behaviour change techniques with effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

There is a need for development of more effective interventions to achieve healthy eating, enhance healthy ageing, and to reduce the risk of age-related diseases. The aim of this study was to identify the behaviour change techniques (BCTs) used in complex dietary behaviour change interventions and to explore the association between BCTs utilised and intervention effectiveness.

METHODS

We undertook a secondary analysis of data from a previous systematic review with meta-analysis of the effectiveness of dietary interventions among people of retirement age. BCTs were identified using the reliable CALO-RE taxonomy in studies reporting fruit and vegetable (F and V) consumption as outcomes. The mean difference in F and V intake between active and control arms was compared between studies in which the BCTs were identified versus those not using the BCTs. Random-effects meta-regression models were used to assess the association of interventions BCTs with F and V intakes.

RESULTS

Twenty-eight of the 40 BCTs listed in the CALO-RE taxonomy were identified in the 22 papers reviewed. Studies using the techniques 'barrier identification/problem solving' (93 g, 95% confidence interval (CI) 48 to 137 greater F and V intake), 'plan social support/social change' (78 g, 95%CI 24 to 132 greater F and V intake), 'goal setting (outcome)' (55 g 95%CI 7 to 103 greater F and V intake), 'use of follow-up prompts' (66 g, 95%CI 10 to 123 greater F and V intake) and 'provide feedback on performance' (39 g, 95%CI -2 to 81 greater F and V intake) were associated with greater effects of interventions on F and V consumption compared with studies not using these BCTs. The number of BCTs per study ranged from 2 to 16 (median = 6). Meta-regression showed that one additional BCT led to 8.3 g (95%CI 0.006 to 16.6 g) increase in F and V intake.

CONCLUSIONS

Overall, this study has identified BCTs associated with effectiveness suggesting that these might be active ingredients of dietary interventions which will be effective in increasing F and V intake in older adults. For interventions targeting those in the peri-retirement age group, 'barrier identification/problem solving' and 'plan for social support/social change' may be particularly useful in increasing the effectiveness of dietary interventions.

Effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Retirement from work involves significant lifestyle changes and may represent an opportunity to promote healthier eating patterns in later life. However, the effectiveness of dietary interventions during this period has not been evaluated.

METHODS

We undertook a systematic review of dietary interventions among adults of retirement transition age (54 to 70 years). Twelve electronic databases were searched for randomized controlled trials evaluating the promotion of a healthy dietary pattern, or its constituent food groups, with three or more months of follow-up and reporting intake of specific food groups. Random-effects models were used to determine the pooled effect sizes. Subgroup analysis and meta-regression were used to assess sources of heterogeneity.

RESULTS

Out of 9,048 publications identified, 68 publications reporting 24 studies fulfilled inclusion criteria. Twenty-two studies, characterized by predominantly overweight and obese participants, were included in the meta-analysis. Overall, interventions increased fruit and vegetable (F&V) intake by 87.5 g/day (P <0.00001), with similar results in the short-to-medium (that is, 4 to 12 months; 85.6 g/day) and long-term (that is, 13 to 58 months; 87.0 g/day) and for body mass index (BMI) stratification. Interventions produced slightly higher intakes of fruit (mean 54.0 g/day) than of vegetables (mean 44.6 g/day), and significant increases in fish (7 g/day, P = 0.03) and decreases in meat intake (9 g/day, P <0.00001).

CONCLUSIONS

Increases in F&V intakes were positively associated with the number of participant intervention contacts. Dietary interventions delivered during the retirement transition are therefore effective, sustainable in the longer term and likely to be of public health significance.

Dietary advice for reducing cardiovascular risk

BACKGROUND

Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain. This review is an update of a previous review published in 2007.

OBJECTIVES

To assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects (DARE) and the HTA database on The Cochrane Library (Issue 4, 2010). We searched MEDLINE (Ovid) (1950 to week 2 October 2010) and EMBASE (Ovid) (1980 to Week 42 2010). Additional searches were done on CAB Health (1972 to December 1999), CVRCT registry (2000), CCT (2000) and SIGLE (1980 to 2000). Dissertation abstracts and reference lists of articles were checked and researchers were contacted.

SELECTION CRITERIA

Randomised studies with no more than 20% loss to follow-up, lasting at least three months and involving healthy adults comparing dietary advice with no advice or minimal advice. Trials involving children, trials to reduce weight or those involving supplementation were excluded.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.

MAIN RESULTS

Forty-four trials with 52 intervention arms (comparisons) comparing dietary advice with no advice were included in the review; 18,175 participants or clusters were randomised. Twenty-nine of the 44 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.15 mmol/L (95% CI 0.06 to 0.23) and LDL cholesterol by 0.16 mmol/L (95% CI 0.08 to 0.24) after 3 to 24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.61 mm Hg systolic (95% CI 1.31 to 3.91) and 1.45 mm Hg diastolic (95% CI 0.68 to 2.22) and 24-hour urinary sodium excretion by 40.9 mmol (95% CI 25.3 to 56.5) after 3 to 36 months but there was heterogeneity between trials for the latter outcome. Three trials reported plasma antioxidants, where small increases were seen in lutein and β-cryptoxanthin, but there was heterogeneity in the trial effects. Self-reported dietary intake may be subject to reporting bias, and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.18 servings/day (95% CI 0.65 to 1.71). Dietary fibre intake increased with advice by 6.5 g/day (95% CI 2.2 to 10.82), while total dietary fat as a percentage of total energy intake fell by 4.48% (95% CI 2.47 to 6.48) with dietary advice, and saturated fat intake fell by 2.39% (95% CI 1.4 to 3.37).Two trials analysed incident cardiovascular disease (CVD) events (TOHP I/II). Follow-up was 77% complete at 10 to 15 years after the end of the intervention period and estimates of event rates lacked precision but suggested that sodium restriction advice probably led to a reduction in cardiovascular events (combined fatal plus non-fatal events) plus revascularisation (TOHP I hazards ratio (HR) 0.59, 95% CI 0.33 to 1.08; TOHP II HR 0.81, 95% CI 0.59 to 1.12).

AUTHORS' CONCLUSIONS

Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 12 months, but longer-term effects are not known.

Results from the dissemination of an evidence-based telephone-delivered intervention for healthy lifestyle and weight loss: the Optimal Health Program

Despite proven efficacy, there are few published evaluations of telephone-delivered interventions targeting physical activity, healthy eating, and weight loss in community dissemination contexts. This study aims to evaluate participant and program outcomes from the Optimal Health Program, a telephone-delivered healthy lifestyle and weight loss program provided by a primary health care organization. Dissemination study used a single-group, repeated measures design; outcomes were assessed at 6-month (mid-program; n = 166) and 12-month (end of program; n = 88) using paired analyses. The program reached a representative sample of at-risk, primary care patients, with 56 % withdrawing before program completion. Among completers, a statistically significant improvement between baseline and end of program was observed for weight [mean change (SE) -5.4 (7.0) kg] and waist circumference [-4.8 (9.7) cm], underpinned by significant physical activity and dietary change. Findings suggest that telephone-delivered weight loss and healthy lifestyle programs can provide an effective model for use in primary care settings, but participant retention remains a challenge.

Bridging the transition from cancer patient to survivor: pilot study results of the Cancer Survivor Telephone Education and Personal Support (C-STEPS) program

OBJECTIVE

To develop a feasibility study of a theory-driven telephone counseling program to enhance psychosocial and physical well-being for cancer survivors after treatment.

METHODS

Participants (n=66) were recruited from two Colorado hospitals with self-administered questionnaires at baseline and two weeks post-intervention. The one group, intervention only design included up to six thematic telephone counseling sessions over three months. Topics included nutrition, physical activity, stress management, and medical follow-up. Primary outcomes were cancer-specific distress, self-reported fruit and vegetable consumption and physical activity.

RESULTS

Of 66 subjects, 46 completed at least one counseling module and the follow-up assessment (70% retention rate). Mean satisfaction was 9 out of 10, and all participants would recommend C-STEPS to other survivors. Cancer-specific distress (Impact of Event Scale - Intrusion subscale) decreased for entire study population (p<0.001) and stress management session participants (p<0.001). Fruit and vegetable consumption increased for nutrition and exercise session participants (p=0.02) and the entire sample (p=NS). Physical activity increased in the entire group (p=0.006) and for nutrition and exercise session participants (p=0.01).

CONCLUSION AND PRACTICE IMPLICATIONS

C-STEPS is a feasible telephone counseling program that transcends geographic barriers, demonstrating the potential to decrease distress and promote coping and healthy lifestyles among cancer survivors.

Dietary advice for reducing cardiovascular risk

BACKGROUND

Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain. This review is an update of a previous review published in 2007.

OBJECTIVES

To assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects (DARE) and the HTA database on The Cochrane Library (Issue 4, 2010). We searched MEDLINE (Ovid) (1950 to week 2 October 2010) and EMBASE (Ovid) (1980 to Week 42 2010). Additional searches were done on CAB Health (1972 to December 1999), CVRCT registry (2000), CCT (2000) and SIGLE (1980 to 2000). Dissertation abstracts and reference lists of articles were checked and researchers were contacted.

SELECTION CRITERIA

Randomised studies with no more than 20% loss to follow-up, lasting at least three months and involving healthy adults comparing dietary advice with no advice or minimal advice. Trials involving children, trials to reduce weight or those involving supplementation were excluded.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.

MAIN RESULTS

Forty-four trials with 52 intervention arms (comparisons) comparing dietary advice with no advice were included in the review; 18,175 participants or clusters were randomised. Twenty-nine of the 44 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.15 mmol/L (95% CI 0.06 to 0.23) and LDL cholesterol by 0.16 mmol/L (95% CI 0.08 to 0.24) after 3 to 24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.61 mm Hg systolic (95% CI 1.31 to 3.91) and 1.45 mm Hg diastolic (95% CI 0.68 to 2.22) and 24-hour urinary sodium excretion by 40.9 mmol (95% CI 25.3 to 56.5) after 3 to 36 months but there was heterogeneity between trials for the latter outcome. Three trials reported plasma antioxidants, where small increases were seen in lutein and β-cryptoxanthin, but there was heterogeneity in the trial effects. Self-reported dietary intake may be subject to reporting bias, and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.18 servings/day (95% CI 0.65 to 1.71). Dietary fibre intake increased with advice by 6.5 g/day (95% CI 2.2 to 10.82), while total dietary fat as a percentage of total energy intake fell by 4.48% (95% CI 2.47 to 6.48) with dietary advice, and saturated fat intake fell by 2.39% (95% CI 1.4 to 3.37).Two trials analysed incident cardiovascular disease (CVD) events (TOHP I/II). Follow-up was 77% complete at 10 to 15 years after the end of the intervention period and estimates of event rates lacked precision but suggested that sodium restriction advice probably led to a reduction in cardiovascular events (combined fatal plus non-fatal events) plus revascularisation (TOHP I hazards ratio (HR) 0.59, 95% CI 0.33 to 1.08; TOHP II HR 0.81, 95% CI 0.59 to 1.12).

AUTHORS' CONCLUSIONS

Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 12 months, but longer-term effects are not known.

Diet adherence dynamics and physiological responses to a tomato product whole-food intervention in African-American men

Tomatoes may have beneficial effects on prostate health. Efficacy trials would require long-term adherence to high levels of tomato product (TP) consumption. Therefore, factors that affect adherence in men most at risk and whether increased consumption of TP negatively affects diet and health are important concerns. Cancer-free African–American (AA) men (n 36) with mean serum prostate-specific antigen of 7.4 SD 5.6) ng/ml were randomised to consume one serving of TP/d or a control diet for 3 months. Mean intervention group lycopene intake rose to 464%, with negligible control group increase. Plasma lycopene levels rose by 53 and 40% in the intervention group in months 1 and 3, respectively (P < 0.0001), with no control group change. The intervention group’s barriers to adherence score was inversely associated with both dietary (r -0.49, P = 0.02) and plasma lycopene concentration (r -0.37, P = 0.02). Their TP disadvantage score negatively correlated with the 3-month plasma lycopene concentrations (r -0.37, P = 0.008) and their weekly incentives and impediments were remarkably stable, ‘concern for prostate health’ being the most consistent over time. ‘Liking tomatoes’ and ‘study participation’ decreased in citation frequency at weeks 6 and 9, respectively. No major shifts occurred in dietary cholesterol or saturated fat, with no adverse effects on gastrointestinal complaints, serum total cholesterol, body weight or blood pressure. Lower socio-economic status AA men at higher prostate cancer risk can successfully achieve a whole food intervention goal with a corresponding rise in plasma lycopene concentrations, with no adverse effects on self-selected diet quality or health parameters.

Implementing Heart Healthy Dietary Guidelines

Over recent decades, abundant scientific evidence has led to authoritative dietary guidelines and recommendations for heart healthy eating and lifestyle behaviors. But most children and adults do not regularly achieve these goals. Consequently, our focus must now be on helping individual patients and our communities implement these guidelines in everyday life. This article reviews current evidence for insights and practical techniques that can help individuals move from ideal goals to real practice of heart healthy nutrition and lifestyle behaviors.

The role of human agents in facilitating clinical and translational science

The fundamental problem confronting policymakers who desire to facilitate the development of clinical and translational science (CTS) comes in bringing people with disparate interests, vocabularies, cultures, goals, and so forth together for a common purpose. A variety of roles have been suggested for individuals who may play key parts in this overall process: opinion leaders, change agents, boundary spanners, structural hole brokers, and, finally, collaborative knowledge brokers. This essay will systematically review these key roles; focusing on the strengths and weaknesses of each to illustrate their part in approaches to solving this problem. The implications of this perspective will be discussed in terms of the role that human agents can play in facilitating CTS.

Behaviour-change interventions in primary care: influence on nutrition and on the metabolic syndrome definers

The purpose of this paper was to examine whether interventions influenced patients' (i) consumption of fish; whole grain products; fruits and vegetables; (ii) overall nutrition, that is, the three former as an index; and (iii) clinical outcomes in terms of metabolic syndrome definers. A questionnaire was delivered to adult patients entering the nine health centres on November 2006 (n = 1211). During the year the ward personnel conducted intervention on patients with unhealthy habits. The 12-month follow up was conducted by mailings. Also clinical data of pre- and post-intervention values of metabolic syndrome definers were collected. For the analyses, intervention was divided into brief (≤ 15 min, at most three visits) and extended (> 15 min, more than three visits) intervention. Logistic Regression and manova were used to measure changes in the outcomes. Nutrition-related intervention was conducted on 218 patients (brief intervention n = 179, extended intervention n = 39). In the extended intervention group it was three times more likely to have a positive change in the nutrition index than in the brief intervention group (P = 0.017, confidence interval 1.223-7.773). In conclusion, brief interventions were commonly used in the primary care. However, they were not enough to produce changes in the patients' nutrition or in the clinical outcomes.

Family functioning, parental psychological distress, child behavioural problems, socio-economic disadvantage and fruit and vegetable consumption among 4-12 year-old Victorians, Australia

The aim of this analysis was to assess relationships between family functioning, parental psychological distress, child behaviour difficulties and fruit and vegetable (F&V) consumption among 4-12-year-old children in Victoria, Australia. We used the 2006 Victorian Child's Health and wellbeing data set that included 3370 randomly selected primary caregivers of 4-12-year-old children interviewed between October 2005 and March 2006. Behavioural problems were measured using the Strengths and Difficulties Questionnaire; level of family functioning was measured using the McMaster Family Assessment Device-General Functioning Scale and parental psychological distress was measured using the Kessler-6 scale. The mean number of servings consumed per day was 2.2 (95% CI: 2.1, 2.3) for fruit and 2.0 (95% CI: 1.9, 2.1) for vegetables. The proportion of children meeting the minimum daily age-specific recommendation was 87.8% (95% CI: 86.4, 89.1%) for fruit and 36.5% (95% CI: 34.5, 38.5) for vegetables. Children with behaviour difficulties, low levels of prosocial behaviours and from poorly functioning households consumed fewer servings of F&V than children who did not experience any environment stressors or behavioural problems. Although parental psychological distress was not associated with fruit intake, daughters of parents who reported higher levels of psychological distress consumed fewer servings of vegetables than daughters of parents who reported lower levels of psychological distress. Child behavioural problems and family functioning and to some extent parental psychological distress were associated with F&V consumption. Programmes aimed at promoting F&V consumption in children should target those families with children experiencing behavioural problems or poorly functioning households.

A randomized trial of tailoring and motivational interviewing to promote fruit and vegetable consumption for cancer prevention and control

BACKGROUND

Healthful dietary patterns, including eating fruits and vegetables (F&V) and avoiding obesity, may decrease the risk of cancer and other chronic diseases. In addition to promoting health for the general population, a cancer diagnosis may provide a "teachable moment," facilitating the adoption of more healthful eating habits and leading to lower risk of chronic disease and better overall health.

PURPOSE

This study was designed to test the effectiveness of two health communication interventions in increasing F&V consumption and physical activity in a sample of older adults (average age of 66 years), including both colorectal cancer (CRC) survivors and noncolorectal cancer-affected (N-CRC) individuals.

METHODS

CRC survivors and N-CRC individuals were recruited from a population-based case-control study and randomly assigned to four conditions using a 2 x 2 design. We tested two different methods of communicating and promoting health behavior change alone or in combination: tailored print communication (TPC) and brief telephone-based motivational interviewing (TMI).

RESULTS

A significant increase in F&V consumption was found for the combined intervention group in the entire sample (p < 0.05). When stratified by cancer survivor status, the effect was concentrated in the N-CRC subset (p < 0.01) versus CRC survivors. The combined intervention was also found to be most cost-effective for the N-CRC group, with TPC more cost-effective than TMI. For physical activity, none of the interventions produced statistically significant improvements.

CONCLUSIONS

This study indicates that combining tailoring and motivational interviewing may be an effective and cost-effective method for promoting dietary behavior change among older healthy adults. More research is needed to identify the optimal dose and timing for intervention strategies to promote dietary and physical activity change among both CRC survivors and the general population.

Telephone intervention promoting weight-related health behaviors

OBJECTIVE

Recent national surveys have documented that the majority of adults in the United States do not meet the recommended levels of healthy lifestyle-related behaviors. The Nutrition and Physical Activity (NuPA) study was designed to promote fruit and vegetable consumption, physical activity, and weight management for a working population.

METHOD

Data were collected nationwide, USA, from 2005 to 2007 and analyzed in 2008. A total of 2470 employed participants were randomized into the self-help (SH: n=1191) or self-help plus telephone counseling (SH+C: n=1279) group. The SH+C group received nine structured telephone counseling sessions in addition to the print materials.

RESULTS

A series of hierarchical regression analyses for each of the health behavior outcomes in the present-at-follow-up subsample (n=1098-1148) revealed that the SH+C was effective in increasing fruit and vegetable consumption. Among the overweight and obese participants, weight loss was significant in both the SH and SH+C groups.

CONCLUSION

Using a theory-based behavioral change counseling technique and targeting multiple health behaviors among employed individuals, our findings demonstrate that the addition of telephone counseling to mailed self-help materials is effective in promoting healthy diet and weight management.

Does tailoring make a difference? A systematic review of the long-term effectiveness of tailored nutrition education for adults

Tailoring individualizes information to the receiver and provides a potential strategy for improving dietary intakes. The present systematic review summarizes evidence for the long-term (> or =6 months) effectiveness of tailored nutrition education for adults and includes priority population groups. Key electronic databases and relevant bibliographies were searched for trials measuring the following outcomes: nutrition-related health behaviors (e.g., dietary intake and food purchases) and anthropometric measures. Data synthesis was comprised of meta-analysis (for 15 trials including all population groups) and narrative review (for five trials of priority population groups). Overall, the quality of the studies was moderate to good. Tailored nutrition education was found to be a promising strategy for improving the diets of adults (including those in priority population groups) over the long term. However, future studies should ensure adequate reporting of research design and methods and reduce the chances of false-positive findings by using more objective measures of diet, clearly identifying the primary study outcome, and concentrating on outcomes most relevant to nutrition-related disease.

Tailoring messages to individual differences in monitoring-blunting styles to increase fruit and vegetable intake

OBJECTIVE

To examine whether messages matched to individuals' monitoring-blunting coping styles (MBCS) are more effective in increasing fruit and vegetable intake than mismatched messages. MBCS refers to the tendency to either attend to and amplify, or distract oneself from and minimize threatening information.

DESIGN/SETTING

Randomly assigned messages were tailored to resonate with either monitors or blunters and delivered at baseline, 1 week, 2 months, and 3 months later. Surveys were conducted at baseline and 2 and 4 months later.

PARTICIPANTS

531 callers to a cancer information hotline who did not meet the 5 A Day guideline.

INTERVENTION

A brief telephone-delivered message and 3 mailings of booklets and promotional items encouraging fruit and vegetable intake, tailored for either monitors or blunters.

MAIN OUTCOME MEASURE

Fruit and vegetable intake 2 and 4 months post-baseline.

ANALYSIS

Hierarchical regression modeling.

RESULTS

Messages matched to MBCS were more effective than mismatched messages, particularly for the monitor message, in increasing intake at 2 months but not at 4 months.

CONCLUSIONS AND IMPLICATIONS

These minimal interventions influenced fruit and vegetable intake. MBCS may be a promising target for developing tailored messages aimed at increasing intake, although additional research is needed to verify the robustness of these findings.

Perceived access to fruits and vegetables associated with increased consumption

Objective

To examine the association between fruit and vegetable access in the community and change in fruit and vegetable consumption among participants in community-based health promotion programmes.

Design

Fruit and vegetable consumption and perceived access to fresh fruit and vegetables were measured by self-administered questionnaires at programme start, end and 1-year follow-up. Community produce availability was determined by grocery store assessments measuring the display space devoted to fruit and vegetable offerings, as well as price, variety and freshness. A total of nine communities were studied; 130 participants completed the fruit and vegetable portions of the questionnaires and could be linked to grocery store assessments.

Results

Participants made modest but significant increases in fruit and vegetable consumption from programme start to end: the average increase was 2·88 (95 % CI 1·52, 4·25) servings weekly; the average increase from start to follow-up was 2·52 (95 % CI 1·09, 3·95) servings weekly. Greater perceived access to fruits and vegetables was significantly associated with higher increases in fruit and vegetable consumption from programme start to programme end. Greater availability of produce was associated with greater increases in fruit and vegetable servings from programme start to programme end as measured by store assessments.

Conclusions

Environmental factors, such as access to fruits and vegetables, can modify the effects of community interventions. Interventions with the goal of increasing fruit and vegetable consumption should consider focusing on increasing access to fresh fruits and vegetables in target communities. Similarly, researchers may want to study access as an intervention, not just a contextual variable.

A randomized trial of a tailored barriers intervention for Cancer Information Service (CIS) callers in pain

Cancer pain management can be improved by overcoming patients' attitudinal barriers to reporting pain and using analgesics. A simple cost-effective barriers intervention designed to reach a large number of persons with cancer has not yet been tested. Such an intervention should be tested against barriers' assessment-alone, as well as no-treatment control. The purpose of this study was to test the efficacy and the cost effectiveness of a tailored barriers intervention (TBI), an educational intervention tailored to participants' attitudinal barriers toward reporting pain and using analgesics. This was a randomized three-group (TBI, assessment-alone, or control) trial with measures at baseline and 28 days later conducted at the NorthCentral and Heartland offices of the Cancer Information Service (CIS), an NCI program that provides information to persons seeking answers to cancer-related questions. Participants (1256 adult CIS callers diagnosed with cancer with moderate to severe pain in the past week) joined the study and were randomized. Of these participants, 970 (77.23%) provided follow-up data. The TBI consisted of educational messages tailored to each participant's attitudinal barriers, delivered orally over the telephone, followed by a printed mailed copy. The outcome measures were attitudinal barriers to pain management, as well as pain outcomes (duration, severity, and interference with life activities). At follow-up the TBI group had significantly lower attitudinal barriers scores compared to assessment-alone and control, but the groups did not differ on the pain outcome variables. TBI and assessment-alone had similar cost effectiveness. The TBI needs to be strengthened to achieve reductions in pain severity.

Pass the fruits and vegetables! A community-university-industry partnership promotes weight loss in African American women

This article describes a community-university-industry partnership to alleviate food insecurity while promoting weight loss. Twenty-one overweight African American women are randomly assigned to experimental or control groups. Each receives supermarket gift cards and brief health education monthly for 3 months. The experimental group buys fresh produce only, whereas the control group buys any groceries. Data on weight, body mass index (BMI), waist-hip circumferences, and dietary intake are collected at baseline and months 1 to 3. Nine (43%) have complete data. Quantitative data reveal that the experimental group have lost significantly more weight (-6, +4 lbs), significantly reduced BMI (-1, +0.7), and eat significantly more raw, fresh produce (1.29, 0.15 cups). A focus group held at month 4 is rich with the meanings of participating, eating "well," and forming new habits. A nutrient-dense diet that is calorically balanced is the hallmark of health and well-being and may be related to weight loss in new ways. However, this diet is not always affordable by those most in need of it. The unexpected outcome of a statistical relationship among consuming raw, freshly prepared produce, weight loss, and BMI reduction within 3 months is not altogether explainable. There are obvious benefits, however, to these outcomes that support the continuing study of the phenomenon.

Tailored telephone education to promote awareness and adoption of fruit and vegetable recommendations among urban and mostly immigrant black men: a randomized controlled trial

BACKGROUND

Fruit and vegetable (FV) intake in black men are far below national recommendations.

METHODS

Urban, primarily immigrant, black men (n=490) from the New York City metropolitan area participating in the Cancer Awareness and Prevention (CAP) Trial (2005-2007) were randomly assigned to one of two intervention groups: 1) FV Education (FVE) or 2) Prostate Education (PE). Both interventions entailed a mailed brochure plus two tailored telephone education (TTE) calls. Outcomes, measured at baseline and at eight months, included knowledge of FV recommendations, perceived benefits, stage of readiness to adopt recommendations and self-reported FV consumption.

RESULTS

At follow-up, the FVE group consumed an average of 1.2 more FV servings per day than the PE group (P<0.001; adjusted for baseline). The FVE group also demonstrated increases in knowledge about recommended FV amounts (P<0.01) and appropriate serving sizes (P<0.05), and in the percent of participants moving from a lower to a higher stage of readiness to adopt FV recommendations (P<0.05). The FVE group did not demonstrate increases in knowledge related to the importance of eating a colorful variety or in the ability to name potential health benefits.

CONCLUSIONS

TTE can be a practical and moderately effective intervention for raising awareness of FV recommendations and for promoting FV consumption in urban and primarily immigrant black men.

Promoting fruit and vegetable intake through messages tailored to individual differences in regulatory focus

BACKGROUND

Researchers must identify strategies to optimize the persuasiveness of messages used in public education campaigns encouraging fruit and vegetable (FV) intake.

PURPOSE

This study examined whether tailoring messages to individuals' regulatory focus (RF), the tendency to be motivated by promotion versus prevention goals, increased the persuasiveness of messages encouraging greater FV intake.

METHOD

Participants (n = 518) completed an assessment of their RF and were randomly assigned to receive either prevention- or promotion-oriented messages. Messages were mailed 1 week, 2 months, and 3 months after the baseline interview. Follow-up assessments were conducted 1 and 4 months after the baseline assessment.

RESULTS

Regression analyses revealed that at Month 4, the messages were somewhat more efficacious when congruent with participants' RF.

CONCLUSION

RF may be a promising target for developing tailored messages promoting increased FV intake, and particularly for encouraging individuals to meet FV guidelines.

Effects of social approval bias on self-reported fruit and vegetable consumption: a randomized controlled trial

Background

Self-reports of dietary intake in the context of nutrition intervention research can be biased by the tendency of respondents to answer consistent with expected norms (social approval bias). The objective of this study was to assess the potential influence of social approval bias on self-reports of fruit and vegetable intake obtained using both food frequency questionnaire (FFQ) and 24-hour recall methods.

Methods

A randomized blinded trial compared reported fruit and vegetable intake among subjects exposed to a potentially biasing prompt to that from control subjects. Subjects included 163 women residing in Colorado between 35 and 65 years of age who were randomly selected and recruited by telephone to complete what they were told would be a future telephone survey about health. Randomly half of the subjects then received a letter prior to the interview describing this as a study of fruit and vegetable intake. The letter included a brief statement of the benefits of fruits and vegetables, a 5-A-Day sticker, and a 5-a-Day refrigerator magnet. The remainder received the same letter, but describing the study purpose only as a more general nutrition survey, with neither the fruit and vegetable message nor the 5-A-Day materials. Subjects were then interviewed on the telephone within 10 days following the letters using an eight-item FFQ and a limited 24-hour recall to estimate fruit and vegetable intake. All interviewers were blinded to the treatment condition.

Results

By the FFQ method, subjects who viewed the potentially biasing prompts reported consuming more fruits and vegetables than did control subjects (5.2 vs. 3.7 servings per day, p < 0.001). By the 24-hour recall method, 61% of the intervention group but only 32% of the control reported eating fruits and vegetables on 3 or more occasions the prior day (p = 0.002). These associations were independent of age, race/ethnicity, education level, self-perceived health status, and time since last medical check-up.

Conclusion

Self-reports of fruit and vegetable intake using either a food frequency questionnaire or a limited 24-hour recall are both susceptible to substantial social approval bias. Valid assessments of intervention effects in nutritional intervention trials may require objective measures of dietary change.

Randomized trial on the 5 a day, the Rio Grande Way Website, a web-based program to improve fruit and vegetable consumption in rural communities

The Internet is a new technology for health communication in communities. The 5 a Day, the Rio Grande Way website intended to increase fruits and vegetables (FV) consumption was evaluated in a rural region enrolling 755 adults (65% Hispanic, 9% Native American, 88% female) in a randomized pretest-posttest controlled trial in 2002-2004. A total of 473 (63%) adults completed a 4-month follow-up. The change in daily intake on a food frequency questionnaire (control: mean = - 0.26 servings; intervention: mean = 0.38; estimated difference = 0.64, SD = 0.52, t(df = 416) = 1.22, p = 0.223) and single item (13.9% eating 5 + servings at pretest, 19.8% posttest for intervention; 17.4%, 13.8% for controls; odds ratio (OR) = 1.84, 95% CI = 1.07, 3.17) was in the expected direction but significant only for the single item. Website use was low and variable (logins: M = 3.3, range = 1 to 39.0; total time: M = 22.2 minutes, range = 0 to 322.7), but it was associated positively with fruit and vegetable intake (total time: Spearman r = 0.14, p = 0.004 for food frequency; Spearman r = 0.135, p = 0.004 for single item). A nutrition website may improve FV intake. The comparison on the food frequency measure may have been undermined by its high variability. Websites may be successful in community settings only when they are used enough by adults to influence them.

Dietary advice for reducing cardiovascular risk

BACKGROUND

Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain.

OBJECTIVES

To assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials, DARE and HTA databases on The Cochrane Library (Issue 4 2006), MEDLINE (1966 to December 2000, 2004 to November 2006) and EMBASE (1985 to December 2000, 2005 to November 2006). Additional searches were done on CAB Health (1972 to December 1999), CVRCT registry (2000), CCT (2000) and SIGLE (1980 to 2000). Dissertation abstracts and reference lists of articles were checked and researchers were contacted.

SELECTION CRITERIA

Randomised studies with no more than 20% loss to follow-up, lasting at least 3 months involving healthy adults comparing dietary advice with no advice or minimal advice. Trials involving children, trials to reduce weight or those involving supplementation were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information.

MAIN RESULTS

Thirty-eight trials with 46 intervention arms (comparisons) comparing dietary advice with no advice were included in the review. 17,871 participants/clusters were randomised. Twenty-six of the 38 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.16 mmol/L (95% CI 0.06 to 0.25) and LDL cholesterol by 0.18 mmol/L (95% CI 0.1 to 0.27) after 3-24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.07 mmHg systolic (95% CI 0.95 to 3.19) and 1.15 mmHg diastolic (95% CI 0.48 to 1.85) and 24-hour urinary sodium excretion by 44.2 mmol (95% CI 33.6 to 54.7) after 3-36 months. Three trials reported plasma antioxidants where small increases were seen in lutein and beta-cryptoxanthin, but there was heterogeneity in the trial effects. Self-reported dietary intake may be subject to reporting bias, and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.25 servings/day (95% CI 0.7 to 1.81). Dietary fibre intake increased with advice by 5.99 g/day (95% CI 1.12 to 10.86), while total dietary fat as a percentage of total energy intake fell by 4.49 % (95% CI 2.31 to 6.66) with dietary advice and saturated fat intake fell by 2.36 % (95% CI 1.32 to 3.39).

AUTHORS' CONCLUSIONS

Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 10 months but longer term effects are not known.

Brief fruit and vegetable messages integrated within a community physical activity program successfully change behaviour

BACKGROUND

Consumption of the recommended amounts of fruits and vegetables is associated with several health benefits. Currently less than 25% of the American population meets the minimum recommendation of five servings a day. In order to change this health behaviour, interventions should be based on theory and include community-wide social support.

METHODS

A low intensity intervention was developed in which participants (n = 86) were randomly assigned to either the fruit and vegetable intervention (FVI) or standard control condition. The intervention was integrated into an ongoing community physical activity program and study participants were drawn from the sample of community members enrolled in the program. The FVI consisted of brief social cognitive theory-based messages delivered in nine weekly newsletters designed to improve participant outcome and self-efficacy expectations related to fruit and vegetable consumption.

RESULTS

Participants in the FVI condition increased in their fruit and vegetable consumption by approximately one to one and one-third servings per day. The control condition showed no change in consumption. The effect of the intervention was enhanced when examined by the extent to which it was adopted by participants (i.e., the number of newsletters read). Those participants who read seven or more newsletters showed an increase of two servings per day.

CONCLUSION

This intervention was effective at improving fruit and vegetable consumption among adults. Minimal interventions, such as newsletters, have the ability to reach large audiences and can be integrated into ongoing health promotion programs. As such, they have potential for a strong public health impact.

Health-related goals in female cancer survivors after treatment

Researchers often have studied cancer treatments and psychosocial aspects of dealing with cancer, but seldom have they evaluated cancer survivors at the end of their treatments or survivors' health-related goals. The purpose of the study was to identify the health-related goals of female cancer survivors at this phase of survivorship. Participants (N = 51) were women who were aged 34 to 77 years and had finished radiation and/or chemotherapy for primary breast or gynecologic cancers. Using a longitudinal design, interviews were conducted within 4 weeks and 3 to 4 months after treatment. Participants answered open-ended questions about their health-related goals. Content analyses were performed on participants' responses. Across interviews, the most common goals were improving physical activity (54-56% in first and second interviews, respectively), performing meaningful activities (26-27%), losing weight (21-22%), and eating a better diet (16-22%). Clinicians can assess for such common goals and address them, as needed, among women with breast or gynecologic cancer. Researchers could design and test the effect of interventions designed to address patients' goals on behavioral and health outcomes among similar cancer survivors.

A first-year community-based service learning elective: design, implementation, and reflection

BACKGROUND

Medical schools have increasingly begun to incorporate service learning practices into their curricula.

DESCRIPTION

As part of a community-based service learning elective, 7 first-year medical students designed and implemented a health behavior education program for residents of a women's substance abuse recovery facility. The resulting program, Start Small, Feel Better, emphasized setting and accomplishing small goals to promote healthy lifestyle modifications.

EVALUATION

We present personal reflections from the students, impressions of the participants, and qualitative data on the short-term effects of this intervention.

CONCLUSIONS

Start Small, Feel Better represents a model of how a service learning project could be put into practice and positively impact both medical students and the broader community.

Telephone-Based Counseling Improves Dietary Fat, Fruit, and Vegetable Consumption: A Best-Evidence Synthesis

Eating more fruits/vegetables and less dietary fat rank among the most important nutrition recommendations for health improvement. Telephone counseling is an increasingly popular means of delivering support for diet modification. Using a best-evidence synthesis, the purpose of this review was to assess the effectiveness of telephone-based counseling on improving dietary fat, fruit, and vegetable consumption for adults. Online databases and article bibliographies were searched to produce relevant randomized-controlled trials published during the past 5 years. Nine studies were ultimately included and the weight of the evidence indicated that telephone-based counseling promotes significantly greater improvements in fruit/vegetable consumption (median effect size=0.41) and dietary fat intake (median effect size=0.22) relative to usual care. Improvements were especially pronounced among women with (or at high risk for developing) cancer. In some studies, telephone-based counseling was also associated with greater improvement in blood lipid levels and weight. Based on these findings, several design considerations (eg, population focus, counseling intensity) for program managers are proposed. Telephone-based counseling was found to be a moderately effective intervention, but there are not enough studies yet to draw conclusions on other research questions, such as how advantageous telephone-based counseling is over traditional forms of dietary counseling. At present, telephone-based counseling may best be used as a complement to clinical care and a means to broaden the outreach of nutrition services.

Supportive care needs of people with brain tumours and their carers

GOALS OF WORK

The diagnosis and treatment of a brain tumour may result in long-term changes in a patient's functional and social abilities and/or in a greatly reduced life span. A qualitative investigation was conducted to examine the supportive care needs of patients with brain tumour and their carers.

MATERIALS AND METHODS

Overall, 18 patients and 18 carers participated in focus groups or telephone interviews, following a structured interview guide to elicit supportive care services of importance to these patients and carers.

MAIN RESULTS

Six major themes were identified using the framework analysis method, including needs for information and coping with uncertainty, practical support, support to return to pretreatment responsibilities or prepare for long-term care, support to deal with social isolation and organize respite care, support to overcome stigma/discrimination and support to discuss potentially reduced life expectancy.

CONCLUSIONS

Five recommendations to improve service delivery include: assignment of a dedicated member of the care team or case manager; proactive dissemination of information, education and psychosocial support; access to objective assessment of neuropsychological functioning; facilitating easier access to welfare payments; and services facilitating communication about difficult illness-related topics. Provision of services along these recommendations could improve supportive care of brain tumour patients and their carers.

Translation as a function of modality: the potential of brief interventions

The purpose of this article is to examine the potential of brief intervention (BI) as a modality for translating health behavior intervention research into practice. We discuss common definitions of BI, applications within common models of translation research, effects of BI on a range of health behaviors and across various populations, current and potential mechanisms, and uses for dissemination to practice. A number of advantages of BI suggest they are well suited for translating behavioral research. In addition, findings from 13 systematic reviews of BI effects show their potential versatility. Basic research on motivation, decision making, and persuasion may be applied to the design of BIs (Type 1 translation). Suggestions for translating BI research into practice are discussed (Type 2 translation). The article concludes that efforts to use BIs to translate research into practice are currently underdeveloped. Recommendations are provided for using BI in translating research into practice.

Need for cognition and message complexity in motivating fruit and vegetable intake among callers to the cancer information service

This field experiment examined the impact of an individual's need for cognition (NFC; the tendency to enjoy thinking deeply about issues), complex versus simple messages, and the interaction of NFC and message type on encouraging fruit and vegetable consumption. Callers to the Cancer Information Service of the National Cancer Institute (N=517) were asked to participate in the experiment at the end of their call. Individual NFC was assessed, and participants were assigned randomly to receive a telephone message promoting fruit and vegetable consumption that was either complex and multifaceted or simple and straightforward. Similarly constructed brochures were mailed immediately following the call, and additional brochures were mailed 2 and 3 months later. Although NFC did not predict intake, complex messages were more effective than simple messages in motivating fruit and vegetable consumption 1 and 4 months later.

Interventions designed to increase adult fruit and vegetable intake can be effective: a systematic review of the literature

International recommendations advise increasing intakes of fruit and vegetables to help reduce the burden of chronic diseases worldwide. This project systematically reviewed evidence on the effectiveness of interventions and programs promoting fruit and/or vegetable intake in adults. In April 2004, we contacted experts in the field and searched 14 publication databases. We considered all papers published in English, French, Spanish, Portuguese, Russian, Danish, Norwegian, and Swedish, and reporting on interventions and promotion programs encouraging higher intakes of fruit and/or vegetables in free-living not acutely ill adults, with follow-up periods > or = 3 mo, that measured change in intake and had a control group. Forty-four studies (mainly from developed countries) were included in the review and stratified by study setting. Larger effects were generally observed in individuals with preexisting health disorders. In primary prevention interventions in healthy adults, fruit and vegetable intake was increased by approximately 0.1-1.4 serving/d. Consistent positive effects were seen in studies involving face-to-face education or counseling, but interventions using telephone contacts or computer-tailored information appeared to be a reasonable alternative. Community-based multicomponent interventions also had positive findings. This literature review suggests that small increases in fruit and vegetable intake are possible in population subgroups, and that these can be achieved by a variety of approaches. More research is required to examine the effectiveness of specific components of interventions in different populations, particularly less developed countries. There is also a need for a better assessment of the effectiveness and cost-effectiveness of large community-based interventions.

Increasing daily fruit and vegetable consumption: what changes do cardiac patients make?

BACKGROUND

Interventions targeting fruit and vegetable consumption report significant increases in consumption but do not detail how increases are achieved. This prospective study explored (i) the changes in daily fruit and daily vegetable consumption of cardiac patients participating in an intervention study and (ii) how participants made these changes.

METHODS

A total of 120 cardiac patients were asked to increase their daily fruit and vegetable consumption by two portions and to maintain this over 3 months. They were telephoned at 7-, 28- and 90-day follow-up to record daily consumption using a dietary questionnaire; 94 participants completed all parts of the study.

RESULTS

Mean reported daily fruit and daily vegetable consumption increased by 1.07 (SD = 1.26) and 0.34 (SD = 0.96) portions, respectively, over 3 months. These increases were statistically significant (P < 0.001) and greatest for participants who reported eating low levels of fruit and vegetables at recruitment. Eating fresh fruit as a snack and at mealtimes were preferred choices for participants.

CONCLUSIONS

Providing information and telephone follow-up could be used by busy healthcare professionals instead of face-to-face contact. Interventions to increase total fruit and vegetable consumption could usefully focus on eating fruit. Interventions to increase vegetable consumption need further investigation.

Improving multiple behaviors for colorectal cancer prevention among african american church members

The WATCH (Wellness for African Americans Through Churches) Project was a randomized trial comparing the effectiveness of 2 strategies to promote colorectal cancer preventive behaviors among 587 African American members of 12 rural North Carolina churches. Using a 2 X 2 factorial research design, the authors compared a tailored print and video (TPV) intervention, consisting of 4 individually tailored newsletters and targeted videotapes, with a lay health advisor (LHA) intervention. Results showed that the TPV intervention significantly improved (p <.05) fruit and vegetable consumption (0.6 servings) and recreational physical activity (2.5 metabolic task equivalents per hour) and, among those 50 and older (n = 287), achieved a 15% increase in fecal occult blood testing screening (p =.08). The LHA intervention did not prove effective, possibly because of suboptimal reach and diffusion.

The CIS model for collaborative research in health communications: a brief retrospective from the current generation of research

The Cancer Information Service (CIS) of the National Cancer Institute (NCI) is the premiere organization for providing cancer information to the nation. The CIS provides a stellar example of how a service organization dedicated to health communications also can serve as a laboratory for research. This journey by the CIS into health communication research is described briefly, along with the current generation of research summarized in this issue of the Journal of Health Communication (JHC). The CIS model for collaborative research is presented as an exemplar that other service organizations might embrace as a strategic tool for quality improvement in health communications.

Multiple tailored messages are effective in increasing fruit and vegetable consumption among callers to the Cancer Information Service

Results are reported from a large (n = 3,402) four-group randomized trial to increase fruit and vegetable consumption among callers to the National Cancer Institute's (NCI's) Cancer Information Service (CIS) using tailored print materials. Following a baseline telephone interview, which included a brief educational message (BEM), participants were assigned randomly within CIS offices to one of four groups: single untailored (SU) group-one untailored set of materials; single tailored (ST) group-one tailored booklet; multiple tailored (MT) group-four tailored materials; and multiple retailored (MRT) group-four tailored materials with retailoring based on new information obtained at 5 months follow-up. Follow-up telephone interviews were conducted at 5 (n = 2,233) and 12 months (n = 1,927) after baseline. The main outcome measure was self-reported fruit and vegetable consumption using a seven-item food frequency questionnaire. At 12 months follow-up, there was a significant linear trend across groups of 0.21 servings (p = 0.0002). Specific nested hypotheses then were tested and revealed significant mean serving differences between SU (5.07) vs. MT (5.64) (p = 0.002) and SU vs. MRT (5.71; p < 0.001). Although the mean for ST (5.40) was greater than that for SU (5.07), the difference was not statistically significant (p = 0.07), and no difference was found between MT vs. MRT (p = 0.69). A higher proportion of recipients of tailored materials reported reading all of the materials and believing that they were written especially for them. No differences by experimental condition were found for the perceived usefulness or motivational impact of the print materials. In this trial, MT print materials were more effective at increasing fruit and vegetable (FV) consumption than were SU materials. The intervention mechanisms responsible for this effect merit further research. Retailoring did not produce a significant difference when compared with longitudinal baseline tailoring.

Increasing the accuracy of perceived breast cancer risk: results from a randomized trial with Cancer Information Service callers

BACKGROUND

Results are reported from a randomized trial designed to increase the accuracy of perceived breast cancer risk among callers to the NCI's Cancer Information Service (CIS) (n = 392).

METHODS

CIS callers assigned to the intervention group (n = 200) received a brief educational intervention and an estimate of breast cancer risk over the telephone at the end of usual service. Follow-up interviews were completed by telephone at 1 month (n = 367).

RESULTS

On average, women overestimated their risk by 25 percentage points. Eighty percent of the respondents rated their risk of breast cancer higher than did the assessment tool. Women rated their risk higher if they were under age 50 (P = 0.025) or had a first-degree family history of breast cancer (P = 0.0001), and rated their risk lower if they were Latina (P = 0.050) or Asian/other race/ethnicity (P = 0.013). Women with a first-degree family history of breast cancer in the intervention group significantly reduced their risk overestimate compared to those in the control group (-12.5 vs. 2.8 percentage points, P = 0.006).

CONCLUSIONS

This intervention was unique because it was delivered in an ongoing service setting. It should be further tested in diverse populations.

Casting health messages in terms of responsibility for dietary change: increasing fruit and vegetable consumption

OBJECTIVE

To compare the effectiveness of messages emphasizing the importance of either personal or social responsibility for dietary behavior change in increasing fruit and vegetable intake.

DESIGN/SETTING

Randomly assigned individually or socially oriented messages were delivered at baseline, 1 week, and 2 and 3 months later. Telephone surveys were conducted at baseline and 1 and 4 months later.

PARTICIPANTS

528 callers to a cancer information hotline who were not meeting the "5 A Day" dietary recommendation.

INTERVENTIONS

A brief telephone-delivered message and 3 mailings of pamphlets and promotional items encouraging fruit and vegetable intake that emphasized either personal or social responsibility.

MAIN OUTCOME MEASURES

Fruit and vegetable intake 1 and 4 months post baseline.

ANALYSIS

Chi-square, t tests, and analyses of variance and covariance.

RESULTS

Both types of messages increased intake substantially (P =.01). To some extent, the social responsibility message continued to motivate increased intake over time compared with the personal responsibility message.

CONCLUSIONS AND IMPLICATIONS

These minimal interventions had a substantial impact on fruit and vegetable intake. Health messages might be more effective over the longer term if they are designed to emphasize the importance of social responsibility, although further study is needed to confirm the robustness of these findings.

Modifying Attributions of Colorectal Cancer Risk

We report how a four-group risk communication intervention targeted to individuals in the carpentry trade affected their perceived causes (i.e., attributions) for increased colorectal cancer (CRC) risk. The intervention varied the amount of information presented on CRC risk factors and whether participants received tailored feedback on their risk factors. In baseline and 3-month follow-up telephone surveys, carpenters (N = 860) reported their perceived absolute and comparative CRC risks, perceived causes for increased CRC risk, and knowledge of CRC risk factors. At follow-up, neither the type or amount of information provided, nor the use of tailoring, appreciably and consistently affected whether participants mentioned their specific risk factor (e.g., lifestyle, occupational) emphasized in their intervention information. Furthermore, attributions did not affect CRC risk perceptions. These results suggest that participants do not integrate sufficiently CRC risk factor information into their conceptualizations of CRC risk, and that more effective methods are needed to contextualize risk factors information to achieve the goal of modifying CRC risk perceptions.

Evaluation of nutrition education interventions for older adults: a proposed framework

This study was undertaken to identify nutrition interventions that could provide a basis for designing effective and measurable nutrition education programs for older adults. The authors conducted a literature search of articles published from 1990-2003 using Medline and Agricola. Key words were "elderly," "older adults," "nutrition intervention," and "nutrition education." Of 128 references identified, 25 studies included intervention and/or evaluation components and targeted adults over age 55 years. Although interventions tended to report limited success in behavior change, certain features had positive outcomes. These included limiting educational messages to one or two; reinforcing and personalizing messages; providing hands-on activities, incentives, cues, and access to health professionals; and using appropriate theories of behavior change. Based on these findings, a theoretical framework that includes these features but is set within a social and environmental context is proposed as a guideline for designing nutrition interventions for older adults.

Estimation of fruit and vegetable intake using a two-item dietary questionnaire: a potential tool for primary health care workers

BACKGROUND AND AIM

High fruit and vegetable intake is associated with health benefits for cancer and cardiovascular disease. An increase is therefore integral in recommendations for the prevention of chronic disease. However, measuring intake requires either extensive dietary assessment or the measurement of specific bio-markers which is neither cheap nor feasible for the routine assessment of an individual's diet in a community or primary care setting. Within the context of a study evaluating a dietary counselling programme to increase fruit and vegetable intake our aim was to assess the use of a simple tool to estimate fruit and vegetable intake.

METHODS AND RESULTS

We studied associations between bio-markers [plasma ascorbic acid, beta-carotene and alpha-tocopherol 24-hour urinary potassium excretion] and a two-item fruit and vegetable consumption questionnaire in 271 subjects (105 men and 166 women), aged 18 to 70 years. After controlling for age, sex, vitamin supplement use, smoking and body mass, those reporting a daily intake of > or = 5 portions of fruit and vegetables had higher potassium excretion (difference 15.6 [95% confidence interval: 6.2 to 25.0] mmol/24 h), urinary potassium/creatinine ratio (1.2 [0.5 to 2.0]) and plasma vitamin C (10.0 [-0.9 to 20.8] mumol/L) than those reporting < or = 2.5 portions per day. beta-carotene (p = 0.04), vitamin C (p = 0.01) and potassium excretion (p < 0.001) were associated with fruit rather than vegetable intake. The two-item questionnaire had high specificity; over 3/4 of participants who reported low intake also had bio-markers below the upper third of the distribution.

CONCLUSION

Self report of fruit and vegetable intake through a simple questionnaire is confirmed by bio-markers for those eating less than five portions of fruit and vegetables a day. Although the tool is amenable to improvements for the detection of vegetable portions, it may prove useful for monitoring dietary preventive approaches in primary care without the use of invasive and costly biochemical measurements.

The impact of communication on cancer risk, incidence, morbidity, mortality, and quality of life

Health communication has great potential to help reduce cancer risks, incidence, morbidity, and mortality while enhancing quality of life across the continuum of cancer care (prevention, detection, diagnosis, treatment, survivorship, and end-of-life care). Effective health communication can encourage cancer prevention, inform cancer detection and diagnosis, guide cancer treatment, support successful cancer survivorship, and promote the best end-of-life care. This article examines the influences of health communication in confronting cancer and promoting important health outcomes. Implications of this analysis are drawn for directing informed cancer communication research and practice.