Use of a Web-based component of a nutrition and physical activity behavioral intervention with Girl Scouts

Impact of troop leader training on the implementation of physical activity opportunities in Girl Scout troop meetings

Girl Scouts (GS) is a setting with large reach to target increased moderate-to-vigorous physical activity (MVPA) in girls. The Scouting Nutrition and Activity Program (SNAP) increased MVPA during intervention troop meetings; therefore, further examination of implementation of SNAP components is warranted to determine the processes contributing to intervention success. The purpose of this study is to examine variability in implementation of an active recreation (AR) policy into GS troop meetings. Troop leaders (n = 7) were randomized to receive SNAP, an intervention training on implementing a policy promoting AR, or a standard control. Meetings (seven meetings/troop) were observed, and girls in attendance (n = 76, 9-13 years, mean ± SD = 10.51 ± 1.19 years) wore ActiGraph GT1M accelerometers. Two observers attended each meeting and recorded start/stop points of AR time segments, as well as other tasks (i.e., opening/closing, snack, and Girl Scout curriculum [GSC]). Time-segmented accelerometer data were analyzed using Evenson cut points and paired with observation data. Researchers observed 181 segments (mean/day ± SD = 3.77 ± 1.24). Intervention troops implemented more AR segments/day (mean/day = 0.86; 95% CI = 0.62-1.09) than control troops (mean/day = 0.18; 95% CI = 0.00-0.39). A greater percentage of time (%time) was spent in MVPA during AR segments (mean = 10.99; 95% CI = 7.16-14.82) compared with GSC segments (mean = 0.73; 95% CI = 0.00-4.10), opening/closing (mean = 3.96; 95% CI = 0.54-7.38), and snack (mean = 0.74; 95% CI = 0.00-4.10) segments, and during opening/closing segments compared with GSC and snack segments. Intervention troops implemented more AR segments than control troops. Troop meeting patterns of PA were influenced by task. Adding time segments conducive to PA could increase the %time spent in MVPA during GS troop meetings.

Wellness-Promoting Practices Through Girl Scouts: A Pragmatic Superiority Randomized Controlled Trial With Additional Dissemination

PURPOSE

To evaluate the effectiveness of in-person versus online Girl Scout leader wellness training for implementation of wellness-promoting practices during troop meetings (phase I) and to assess training adoption and current practices across the council (phase II).

DESIGN

Pragmatic superiority trial (phase 1) followed by serial cross-sectional study (phase II).

SETTING

Girl Scout troop meetings in Northeast Kansas.

PARTICIPANTS

Eighteen troop leaders from 3 counties (phase 1); 113 troop leaders from 7 counties (phase II).

INTERVENTION

Phase I: Troop leaders attended 2 wellness training sessions (first in groups, second individually), wherein leaders set wellness-promoting practice implementation goals, self-monitored progress, and received guidance and resources for implementation. Leaders received the intervention in person or online.

MEASURES

Phase I: At baseline and postintervention, leaders completed a wellness-promoting practice implementation questionnaire assessing practices during troop meetings (max score = 11). Phase II: Leaders completed a survey about typical troop practices and interest in further training.

ANALYSIS

Phase I: Generalized linear mixed modeling.

RESULTS

Phase I: In-person training increased wellness-promoting practice implementation more than online training (in person = 2.1 ± 1.8; online = 0.2 ± 1.2; P = .022). Phase II: Fifty-six percent of leaders adopted the training. For 8 of 11 wellness categories, greater than 50% of leaders employed wellness-promoting practices.

CONCLUSION

In-person training was superior to online training for improvements in wellness-promoting practices. Wellness training was adopted by the majority of leaders across the council.

The effects of a multi-component higher-functioning autism anti-stigma program on adolescent boys

A six-session higher-functioning autism anti-stigma program incorporating descriptive, explanatory and directive information was delivered to adolescent boys and the impact upon knowledge, attitudes and behavioural intentions towards peers with autism was evaluated. Participants were seventh-, eighth- and ninth-grade students (N = 395) from regular classes in a mainstream school. Two-eighth-grade classes were randomly allocated to the intervention condition and all remaining students were either allocated to the no-intervention peer or no-intervention non-peer condition. The anti-stigma program improved the knowledge and attitudes, but not the behavioural intentions of participants towards their peers with autism. Knowledge and attitudinal changes were maintained at follow-up. There were no spill-over effects of the program to non-targeted students. These results provide some preliminary evidence for the effectiveness of multi-session anti-stigma programs incorporating combined information for adolescent students in inclusive educational environments.

A systematic review of the use and effectiveness of social media in child health

Background

Social media use is highly prevalent among children, youth, and their caregivers, and its use in healthcare is being explored. The objective of this study was to conduct a systematic review to determine: 1) for what purposes social media is being used in child health and its effectiveness; and 2) the attributes of social media tools that may explain how they are or are not effective.

Methods

We searched Medline, CENTRAL, ERIC, PubMed, CINAHL, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge, and Proquest Dissertation and Theses Database from 2000–2013. We included primary research that evaluated the use of a social media tool, and targeted children, youth, or their families or caregivers. Quality assessment was conducted on all included analytic studies using tools specific to different quantitative designs.

Results

We identified 25 studies relevant to child health. The majority targeted adolescents (64%), evaluated social media for health promotion (52%), and used discussion forums (68%). Most often, social media was included as a component of a complex intervention (64%). Due to heterogeneity in conditions, tools, and outcomes, results were not pooled across studies. Attributes of social media perceived to be effective included its use as a distraction in younger children, and its ability to facilitate communication between peers among adolescents. While most authors presented positive conclusions about the social media tool being studied (80%), there is little high quality evidence of improved outcomes to support this claim.

Conclusions

This comprehensive review demonstrates that social media is being used for a variety of conditions and purposes in child health. The findings provide a foundation from which clinicians and researchers can build in the future by identifying tools that have been developed, describing how they have been used, and isolating components that have been effective.

Social media interventions for diet and exercise behaviours: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVES

To conduct a systematic review of randomised controlled trials (RCTs) examining the use of social media to promote healthy diet and exercise in the general population.

DATA SOURCES

MEDLINE, CENTRAL, ERIC, PubMed, CINAHL, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge and ProQuest Dissertation and Thesis (2000-2013).

STUDY ELIGIBILITY CRITERIA

RCTs of social media interventions promoting healthy diet and exercise behaviours in the general population were eligible. Interventions using social media, alone or as part of a complex intervention, were included.

STUDY APPRAISAL AND SYNTHESIS

Study quality was assessed using the Cochrane Risk of Bias Tool. We describe the studies according to the target populations, objectives and nature of interventions, outcomes examined, and results and conclusions. We extracted data on the primary and secondary outcomes examined in each study. Where the same outcome was assessed in at least three studies, we combined data in a meta-analysis.

RESULTS

22 studies were included. Participants were typically middle-aged Caucasian women of mid-to-high socioeconomic status. There were a variety of interventions, comparison groups and outcomes. All studies showed a decrease in programme usage throughout the intervention period. Overall, no significant differences were found for primary outcomes which varied across studies. Meta-analysis showed no significant differences in changes in physical activity (standardised mean difference (SMD) 0.13 (95% CI -0.04 to 0.30), 12 studies) and weight (SMD -0.00 (95% CI -0.19 to 0.19), 10 studies); however, pooled results from five studies showed a significant decrease in dietary fat consumption with social media (SMD -0.35 (95% CI -0.68 to -0.02)).

CONCLUSIONS

Social media may provide certain advantages for public health interventions; however, studies of social media interventions to date relating to healthy lifestyles tend to show low levels of participation and do not show significant differences between groups in key outcomes.

Physical activity promotion and obesity prevention in Girl Scouts: Scouting Nutrition and Activity Program+

BACKGROUND

A previous version of Scouting Nutrition and Activity Program (SNAP) resulted in greater physical activity (PA) during troop meetings, but no impact on girls' body mass index (BMI) or overall PA. The purpose of this study was to evaluate the effects of a 6-month intervention that coupled the evidence-based program SNAP with a channel of communication to parents using health report cards.

METHODS

Thirty-two Girl Scouts (mean age = 9.5, SD = 1.4 years) received the SNAP+ intervention. Girls were measured before and after the intervention on body composition, BMI, and 7-day step counts. Troop leaders were trained to implement an interactive obesity-prevention curriculum. Parents received health report cards designed to provide personalized information about their daughters' PA and weight status.

RESULTS

The full sample of participants took more steps per day after the intervention (mean difference = 1741, P= 0.007). Results showed that lower values for body fat percentage (P= 0.620), BMI percentile (P= 0.100) and BMI z-scores (P= 0.055) at intervention end were not statistically significant. In the subsample of girls at risk for overweight and obesity, there were lower values for BMI z-score (P= 0.010), BMI percentile (P= 0.027), and body fat percentage (P= 0.053).

CONCLUSIONS

From this preliminary study, the SNAP+ intervention appears to be effective for Scout-based promotion of PA, and for the prevention of overweight and obesity in at-risk Girl Scouts, but further evaluation through a fully powered randomized controlled trial is warranted.

Validation of a milk consumption stage of change algorithm among adolescent survivors of childhood cancer

OBJECTIVE

To assess the construct validity of a milk consumption Stages of Change (SOC) algorithm among adolescent survivors of childhood cancer ages 11 to 21 years (n = 75).

METHODS

Baseline data from a randomized controlled trial designed to evaluate a health behavior intervention were analyzed. Assessments included a milk consumption SOC algorithm and hypothesized theoretical and behavioral predictors of SOC.

RESULTS

Compared with survivors who expressed no readiness to change, those expressing readiness to change behavior for both 2 and 4 daily servings of milk reported more frequent milk consumption (P < .001), greater dietary calcium intake (P = .006), and were more likely to meet age-specific recommendations for daily calcium intake (P = .01).

CONCLUSIONS AND IMPLICATIONS

Results provide support for the construct validity of the milk consumption SOC algorithm relative to behavioral criteria. Research is needed to further examine algorithm validity with respect to theoretical predictors of SOC.

Efficacy of the Survivor Health and Resilience Education (SHARE) program to improve bone health behaviors among adolescent survivors of childhood cancer

PURPOSE

The purpose of this study is to test the efficacy of the Survivor Health and Resilience Education Program intervention--a manualized, behavioral intervention focusing on bone health behaviors among adolescent survivors of childhood cancer.

METHODS

Participants were 75 teens aged 11-21 years, one or more years post-treatment, and currently cancer-free. Teens were randomized to a group-based intervention focusing on bone health or a wait-list control. Bone health behaviors were assessed at baseline and 1-month post-intervention.

RESULTS

Controlling for baseline outcome measures and theoretical predictors, milk consumption frequency (p=0.03), past month calcium supplementation (p<0.001), days in the past month with calcium supplementation (p<0.001), and dietary calcium intake (p=0.04) were significantly greater at 1-month follow-up among intervention participants compared with control participants.

CONCLUSIONS

The intervention had a significant short-term impact on self-reported bone health behaviors among adolescent survivors of childhood cancer. Research examining long-term intervention effectiveness is warranted.

The efficacy of the web-based childhood obesity prevention program in Chinese American adolescents (Web ABC study)

PURPOSE

To examine the feasibility and efficacy of a theory-driven and family-based program delivered online to promote healthy lifestyles and weights in Chinese American adolescents.

METHODS

A randomized controlled study of a web-based intervention was developed and conducted in 54 Chinese American adolescents (ages, 12-15 years) and their families. Data on anthropometry, blood pressure, dietary intake, physical activity, and knowledge and self-efficacy regarding physical activity and nutrition were collected at baseline and 2, 6, and 8 months after the baseline assessment. Data were analyzed using linear mixed modeling.

RESULTS

The intervention resulted in significant decreases in waist-to-hip ratio and diastolic blood pressure and increases in vegetable and fruit intake, level of physical activity, and knowledge about physical activity and nutrition.

CONCLUSION

This web-based behavior program for Chinese American adolescents and their families seems feasible and effective in the short-term. Long-term effects remain to be determined. This type of program can be adapted for other minority ethnic groups who are at high-risk for overweight and obesity and have limited access to programs that promote healthy lifestyles.

A group-randomized controlled trial for health promotion in Girl Scouts: healthier troops in a SNAP (Scouting Nutrition & Activity Program)

BACKGROUND

Girl Scouting may offer a viable channel for health promotion and obesity prevention programs. This study evaluated the effectiveness of an intervention program delivered through Girl Scout Junior troops that was designed to foster healthful troop meeting environments and increase obesity prevention behaviors at home.

METHODS

Seven Girl Scout troops were randomized to intervention (n = 3, with 34 girls) or standard-care control (n = 4, with 42 girls) conditions. Girls ranged in age from 9 to 13 years (mean 10.5 years). Intervention troop leaders were trained to implement policies promoting physical activity (PA) and healthful eating opportunities at troop meetings, and to implement a curriculum promoting obesity-prevention behaviors at home. The primary outcome variable was child body mass index (BMI) z-score. Secondary outcomes included accelerometer-assessed PA levels in troop meetings, direct observations of snack offerings, time spent in physically active meeting content, and leader encouragement of PA and healthful eating.

RESULTS

The intervention was delivered with good fidelity, and intervention troops provided greater opportunities for healthful eating and PA (x2 = 210.8, p < .001), relative to control troops. In troop meetings, intervention troop leaders promoted PA (x2 = 23.46, p < .001) and healthful eating (x2 = 18.14, p < .001) more frequently, and discouraged healthful eating and PA less frequently (x2 = 9.63, p = .002) compared to control troop leaders. Most effects of the intervention on individual-level variables of girls and parents were not significantly different from the control condition, including the primary outcome of child BMI z-score (F1, 5 = 0.42, p = .544), parent BMI (F1, 5 = 1.58, p = .264), and related behavioral variables. The notable exception was for objectively assessed troop PA, wherein girls in intervention troops accumulated significantly less sedentary (x2 = 6.3, p = .011), significantly more moderate (x2 = 8.2, p = .004), and more moderate-to-vigorous physical activity, (x2 = 18.4, p < .001), than girls in control troops.

CONCLUSIONS

Implementing a health promotion curriculum and supporting policies to provide more healthful environments in Girl Scout troop meetings appears feasible on a broader scale. Additional work is needed to bridge health promotion from such settings to other environments if lasting individual-level behavior change and obesity prevention remain targeted outcomes.

TRIAL REGISTRATION NUMBER

NCT00949637.

[Effect of an on-line health promotion program connected with a hospital health examination center on health promotion behavior and health status]

PURPOSE

The purpose of this study was to evaluate the effect of an On-line health promotion program connected with a hospital health examination center.

METHODS

Based on contents developed, the www.kmwellbeing.com homepage was developed. The research design was a one group pretest-posttest design. Seventy-three clients participated in this study. The data were collected from January 3 to June 30, 2005. As a way of utilizing the homepage, this paper attempted to measure the change of pre and post program health promotion behavior and health status (perceived health status, objective health index-blood pressure, pulse, total cholesterol, blood sugar, waist flexibility, grip strength and lower extremity strength). Data were analyzed by descriptive statistics and paired t-test with the SPSS/Win 12.0 program.

RESULTS

There were significant differences of perceived health status, systolic BP, waist flexibility and grip strength. However, there were no significant differences in health promotion behavior, diastolic BP, pulse, lower extremity strength, blood sugar and total cholesterol between pre program and post program.

CONCLUSION

It is expected that an on-line health promotion program connected with a hospital health examination center will provide an effective learning media for health education and partially contribute to client's health promotion. A strategy, however, is needed to facilitate the continuous use of the on-line health promotion program for adult clients.

Real world use of an Internet intervention for pediatric encopresis

BACKGROUND

The Internet is a significant source of medical information and is now being shown to be an important conduit for delivering various health-related interventions.

OBJECTIVE

This paper aimed to examine the utility and impact of an Internet intervention for childhood encopresis as part of standard medical care in a "real world" setting.

METHODS

Patients diagnosed with encopresis were given a Web-based information prescription to use an Internet intervention for pediatric encopresis. A total of 22 families utilized the intervention between July 2004 and June 2006. A chart review and phone interview were undertaken to collect user characteristics; defecation-related information, including frequency of soiling, bowel movements (BMs) in the toilet, and amount of pain associated with defecation; and information on computer/Internet usage. Three questionnaires were used to examine the utility of, impact of, and adherence to the Internet intervention. Program utilization was obtained from a data tracking system that monitored usage in real time.

RESULTS

Overall, parents rated the Internet intervention as enjoyable, understandable, and easy to use. They indicated that the Internet intervention positively affected their children, decreasing overall accidents and increasing child comfort on the toilet at home. Of the 20 children who initially reported fecal accidents, 19 (95%) experienced at least a 50% improvement, with a reduction of accident frequency from one fecal accident per day to one accident per week. Although it is not clear whether this improvement is directly related to the use of the Internet intervention, patient feedback suggests that the program was an important element, further establishing Internet interventions as a viable and desirable addition to standard medical care for pediatric encopresis.

CONCLUSIONS

To our knowledge, this is the first time a pediatric Internet intervention has been examined as part of a "real world" setting. This is an important step toward establishing Internet interventions as an adjunctive component to treatment of pediatric patients in a clinical setting, particularly given the positive user feedback, possible cost savings, and significant potential for large-scale dissemination.

State of the Art Reviews: Using the Internet to Promote Physical Activity and Healthy Eating in Youth

The prevalence of overweight children and adolescents is increasing at alarming rates. Since 1980, the prevalence of overweight among children aged 6 to 11 years has more than doubled and more than tripled among adolescents aged 12 to 19. Innovative, effective weight loss strategies that effectively promote healthy eating and physical activity are needed to address this obesity epidemic. The Internet may prove to be an effective means of reaching youth to reduce overweight and, ideally, prevent weight gain. This article reviews the available literature of Internet-based interventions promoting healthy eating, physical activity, and/ or weight loss in school, home, camp, and medical settings. Findings show that few examples of well-designed trials exist in the youth literature. However, several studies show promise for the use of the Internet. It is recommended that future trials use adequate sample sizes, randomized designs, objective measures, boys and girls, health disparity youth, longer intervention periods (at least 16 weeks), long-term follow-up, theory-based skill building (eg, tracking of behavior, goal setting, feedback, increasing social support), the involvement of parents or caretakers, and improved means for sustaining interest and use in the site over time.

Effective osteoporosis education in the outpatient orthopaedic setting

BACKGROUND

The orthopaedic surgeon may be the first medical specialist to interact with a patient with clinically important osteoporosis, providing an opportunity to educate that patient about this disease. The purpose of the present study was to investigate whether patients could be effectively educated with regard to osteoporosis and lifestyle modification during their outpatient visits to an orthopaedic surgeon's office.

METHODS

Eighty female patients ranging from fifteen to seventy-three years of age completed an eleven-question quiz that included items regarding their knowledge of osteoporosis, calcium intake, menopausal status, exercise, smoking, and whether or not they had had a bone mineral density scan. The quiz was completed during a visit to an outpatient sports medicine/general orthopaedic clinic. After the quiz, an educational intervention was performed by providing the patients with an informational handout. The patients were followed at an average interval of six months and were reassessed either in the office or over the telephone with use of the same quiz to evaluate increases in knowledge and modification of lifestyle.

RESULTS

Fifty-four premenopausal and twenty-six postmenopausal patients were available for follow-up. The premenopausal and postmenopausal groups differed at the beginning of the study, with premenopausal patients having a higher daily calcium intake (p = 0.008) and a better ability to define osteoporosis (p = 0.004) and postmenopausal patients having a higher rate of having had a prior bone mineral density scan (p < 0.001). In response to the educational intervention, significant improvements were seen in terms of the patients' ability to define osteoporosis (p = 0.004), the ability to identify being female as a major risk factor (p < 0.001), and the understanding that females should begin adequate calcium intake at a young age (p < 0.001). Significant increases in daily calcium intake (p < 0.001) and exercise level also occurred (p < 0.003). The postmenopausal group demonstrated a less robust response to the educational intervention.

CONCLUSIONS

The outpatient orthopaedic sports medicine office setting represents a prime opportunity for education regarding osteoporosis prevention and lifestyle modification that can be performed in an inexpensive fashion and that can be easily replicated in most offices both in the community and in academic settings.