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Chan CMJ, Müller-Riemenschneider F, Chia MYH, Hildon ZJL, Chong MFF. Promoting hEalthy Diet and Active Lifestyle (PEDAL): a protocol for the development and feasibility study of a multicomponent intervention among primary school children in Singapore. Pilot Feasibility Stud 2024; 10:52. [PMID: 38521958 PMCID: PMC10960416 DOI: 10.1186/s40814-024-01479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Setting healthy lifestyle habits during the formative years of childhood is critical as habits can track to adulthood and help prevent obesity and chronic disease risks in later life. While multicomponent interventions have been shown to be effective in changing the lifestyle behaviours of children, there is a limited understanding of the feasibility of such interventions in primary schools in Singapore. A multiphase mixed method study was conducted to develop and examine the feasibility of a theory-based multicomponent school-based intervention-Promoting hEatlthy Eating and Active Lifestyle (PEDAL). METHODS Underpinned by Kincaid's ideation model, the PEDAL intervention was developed to increase fruit and vegetable consumption and decrease sedentary behaviours among children. This study consists of three phases. Phase 1 details the development of PEDAL, which consists of four components: (A) a series of interactive health education lessons, (B) actionable home activities to support habit formation, (C) parental/guardian engagement, and (D) optimising the school environment. In Phase 2, components A and B of PEDAL were implemented in two public, co-educational primary schools among Primary 5 students (aged 10-12 years) in Singapore. Data was collected quantitatively using questionnaires and qualitatively using focus group discussions (FGDs) with students and teachers. The feasibility dimensions of components A and B, including recruitment capability, data collection, social validity, and practicality were examined, and ideation on healthy eating and physical activity was explored. In Phase 3, the full PEDAL intervention was pilot-tested in two other public, co-education primary schools with the same target population, using a concurrent mixed method quasi-experimental study design. Feasibility dimensions and potential effectiveness of the intervention will be assessed. DISCUSSION This study will provide insights into the feasibility of PEDAL and inform its refinement. Findings from the pilot test will guide the planning of a larger-scale definitive trial. TRIAL REGISTRATION Registered with ISRCTN registry (ISRCTN16114046) on 16 October 2022.
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Affiliation(s)
- Cindy Mei Jun Chan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore
- Center for Digital Health, Berlin Institute of Health (BIH), Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Michael Yong Hwa Chia
- Physical Education & Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Zoe Jane-Lara Hildon
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore.
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.
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Smith S, Lally P, Steptoe A, Chavez-Ugalde Y, Beeken RJ, Fisher A. Prevalence of loneliness and associations with health behaviours and body mass index in 5835 people living with and beyond cancer: a cross-sectional study. BMC Public Health 2024; 24:635. [PMID: 38419011 PMCID: PMC10903019 DOI: 10.1186/s12889-024-17797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND A cancer diagnosis and its treatment may be an especially isolating experience. Despite evidence that positive health behaviours can improve outcomes for people living with and beyond cancer (LWBC), no studies have examined associations between loneliness and different health behaviours in this population. This study aimed to describe the prevalence of loneliness in a large sample of UK adults LWBC and to explore whether loneliness was associated with multiple health behaviours. METHODS Participants were adults (aged ≥ 18 years) diagnosed with breast, prostate or colorectal cancer who completed the Health and Lifestyle After Cancer Survey. Loneliness was reported using the UCLA loneliness score, dichotomised into higher (≥ 6) versus lower (< 6) loneliness. Engagement in moderate-to-vigorous physical activity, dietary intake, smoking status, alcohol use, and self-reported height and weight were recorded. Behaviours were coded to reflect meeting or not meeting the World Cancer Research Fund recommendations for people LWBC. Logistic regression analyses explored associations between loneliness and health behaviours. Covariates were age, sex, ethnicity, education, marital status, living situation, cancer type, spread and treatment, time since treatment, time since diagnosis and number of comorbid conditions. Multiple imputation was used to account for missing data. RESULTS 5835 participants, mean age 67.4 (standard deviation = 11.8) years, completed the survey. 56% were female (n = 3266) and 44% (n = 2553) male, and 48% (n = 2786) were living with or beyond breast cancer, 32% (n = 1839) prostate, and 21% (n = 1210) colorectal. Of 5485 who completed the loneliness scale, 81% (n = 4423) of participants reported lower and 19% (n = 1035) higher loneliness. After adjustment for confounders, those reporting higher levels of loneliness had lower odds of meeting the WCRF recommendations for moderate-to-vigorous physical activity (Odds Ratio [OR] 0.78, 95% Confidence Internal [CI], 0.67, 0.97, p =.028), fruit and vegetable intake (OR 0.81, CI 0.67, 1.00, p =.046), and smoking (OR 0.62, 0.46, 0.84, p =.003). No association was observed between loneliness and the other dietary behaviours, alcohol, or body mass index. CONCLUSIONS Loneliness is relatively common in people LWBC and may represent an unmet need. People LWBC who experience higher levels of loneliness may need additional support to improve their health behaviours.
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Affiliation(s)
- Susan Smith
- Department of Behavioural Science and Health, University College London, Gower Street, WC1E 6BT, London, UK
| | - Phillippa Lally
- Department of Psychological Sciences, University of Surrey, GU2 7XH, Guildford, Surrey, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, Gower Street, WC1E 6BT, London, UK
| | - Yanaina Chavez-Ugalde
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, Box 285, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, LS2 9JT, Leeds, UK
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, Gower Street, WC1E 6BT, London, UK.
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Cradock A, Barrett J, Nink E, Wilking C. An economic evaluation of strategies to ensure safer drinking water in the homes of families with young children in select United States locations. Prev Med Rep 2024; 38:102588. [PMID: 38283965 PMCID: PMC10818245 DOI: 10.1016/j.pmedr.2024.102588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Introduction In the United States, safe, accessible drinking water is not equitable due to source water contamination, unreliable water treatment, or hazardous plumbing infrastructure. Drinking water free of lead, nitrates, and arsenic is vital for infant and young children's health. Methods Researchers conducted a study combining single-case study review methods and economic evaluation for 6 US policies or programs. Researchers used case-study findings, activity-based costing, publicly available US population data, and existing literature to create 5-year cost projections (2020-2024) for strategies to address lead, nitrates, or arsenic in drinking water from private wells or community water systems for families with low incomes and young children aged 0-5y. Researchers estimated the number of households reached and the costs by activity and payer of implementing each policy or program using case-specific geographic location and eligibility criteria. Results The total number of households reached varied from 295 to 135,000 depending on water source, population of focus, and geographic location. Focused strategies reached higher proportions of families with low incomes and young children. Community water system and state-wide strategies had the broadest reach. The total annual program cost per household that received information about their water quality ranged from $75 to $2,780. Of this cost, the portion paid by the household varied from $0.12 to $1,590, not including mitigation. Conclusions These findings can inform local decisions about policies and programs in communities seeking to increase awareness and access to safer drinking water, particularly in homes of families with low incomes and young children.
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Affiliation(s)
- A.L. Cradock
- Prevention Research Center on Nutrition and Physical Activity, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA 02115, United States
| | - J.L. Barrett
- Prevention Research Center on Nutrition and Physical Activity, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA 02115, United States
| | - E. Nink
- ICF International, 1902 Reston Metro Plaza, Reston, VA 20190, United States
| | - C. Wilking
- Independent Legal Consultant, PO BOX 503, Cummaquid, MA 02637, United States
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Chan J, Conroy P, Phongsavan P, Raubenheimer D, Allman-Farinelli M. Systems map of interventions to improve dietary intake of pre-school aged children: A scoping review. Prev Med 2023; 177:107727. [PMID: 37848165 DOI: 10.1016/j.ypmed.2023.107727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023]
Abstract
Implementation and sustaining impact of early childhood nutrition interventions in practice remains a challenge. An understanding of the extent to which determinants across multiple levels of the food system are being addressed may improve success. This literature review aimed to synthesise the evidence on interventions targeting dietary intake and eating behaviours in preschool children using a systems approach. Eligible studies included intervention studies targeting the dietary intake of preschool children aged 2-5 years in high income countries, published in English after January 2000. Interventions were categorised to the Determinants of Nutrition and Eating (DONE) framework for children developed and evaluated by experts across multiple fields. The framework maps and ranks 411 factors driving eating behaviours and nutrition and can be used to systematically summarise determinants. DONE ranks each determinant for its perceived research priority. A total of 160 eligible studies were identified. Most interventions targeted interpersonal (n = 101, 63.1%) and individual (n = 85, 53.1%) level determinants, with fewer targeting environmental (n = 55, 34.4%) and policy level (n = 17, 10.6%) determinants. The most frequently addressed determinants were Parental Resources and Risk Factors (n = 85) and Children's Food Knowledge, Skills and Abilities (n = 67). These determinants had a Moderate research priority rating. Home Food Availability and Accessibility at the environmental level is classified as the highest research priority, however, only 15 of 160 interventions addressed this determinant. This review highlights home food availability and accessibility as potential leverage points for future interventions to improve children's dietary intake and eating behaviours.
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Affiliation(s)
- Jacqueline Chan
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.
| | - Patrick Conroy
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Philayrath Phongsavan
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia; Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Raubenheimer
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia; School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Margaret Allman-Farinelli
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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Conceição ISR, Garcia-Burgos D, de Macêdo PFC, Nepomuceno CMM, Pereira EM, Cunha CDM, Ribeiro CDF, de Santana MLP. Habits and Persistent Food Restriction in Patients with Anorexia Nervosa: A Scoping Review. Behav Sci (Basel) 2023; 13:883. [PMID: 37998630 PMCID: PMC10669471 DOI: 10.3390/bs13110883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023] Open
Abstract
The aetiology of anorexia nervosa (AN) presents a puzzle for researchers. Recent research has sought to understand the behavioural and neural mechanisms of these patients' persistent choice of calorie restriction. This scoping review aims to map the literature on the contribution of habit-based learning to food restriction in AN. PRISMA-ScR guidelines were adopted. The search strategy was applied to seven databases and to grey literature. A total of 35 studies were included in this review. The results indicate that the habit-based learning model has gained substantial attention in current research, employing neuroimaging methods, scales, and behavioural techniques. Food choices were strongly associated with dorsal striatum activity, and habitual food restriction based on the self-report restriction index was associated with clinical impairment in people chronically ill with restricting AN. High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and Regulating Emotions and Changing Habits (REaCH) have emerged as potential treatments. Future research should employ longitudinal studies to investigate the time required for habit-based learning and analyse how developmental status, such as adolescence, influences the role of habits in the progression and severity of diet-related illnesses. Ultimately, seeking effective strategies to modify persistent dietary restrictions controlled by habits remains essential.
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Affiliation(s)
- Ismara Santos Rocha Conceição
- Graduate Program in Food, Nutrition and Health, School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (I.S.R.C.); (P.F.C.d.M.)
| | - David Garcia-Burgos
- Department of Psychobiology, The “Federico Olóriz” Institute of Neurosciences, Biomedical Research Centre, University of Granada, 18071 Granada, Spain;
| | - Patrícia Fortes Cavalcanti de Macêdo
- Graduate Program in Food, Nutrition and Health, School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (I.S.R.C.); (P.F.C.d.M.)
| | | | | | - Carla de Magalhães Cunha
- School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (C.d.M.C.); (C.D.F.R.)
| | - Camila Duarte Ferreira Ribeiro
- School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (C.d.M.C.); (C.D.F.R.)
- Graduate Program in Food Science, Faculty of Pharmacy, Federal University of Bahia, Salvador 40170-115, Brazil
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Kennedy F, Lally P, Miller NE, Conway RE, Roberts A, Croker H, Fisher A, Beeken RJ. Fatigue, quality of life and associations with adherence to the World Cancer Research Fund guidelines for health behaviours in 5835 adults living with and beyond breast, prostate and colorectal cancer in England: A cross-sectional study. Cancer Med 2023; 12:12705-12716. [PMID: 37021752 PMCID: PMC10278485 DOI: 10.1002/cam4.5899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Many individuals living with and beyond cancer (LWBC) have ongoing quality of life (QoL) issues, including fatigue. The World Cancer Research Fund (WCRF) provides health behaviour recommendations for people LWBC, and there is some evidence linking adherence to these with improved QoL. METHODS Adults LWBC (specifically breast, colorectal or prostate cancer) completed a survey covering health behaviours (diet, physical activity, alcohol consumption and smoking), fatigue (FACIT-Fatigue Scale, version 4) and a broad measure of QoL (EQ-5D-5L descriptive scale). Participants were categorised as meeting/not meeting WCRF recommendations, using the following cut-offs classified as meeting the guidelines: ≥150 min physical activity/week, fruit and vegetables (≥5 portions/day), fibre (≥30 g fibre per day), free sugar (<5% of total calories from free sugar), fat (<33% total energy), red meat (<500 g/week), processed meat (none), alcohol consumption (<14 units/week) and not a current smoker. Logistic regression analyses explored associations between WCRF adherence and fatigue and QoL issues, controlling for demographic and clinical variables. RESULTS Among 5835 individuals LWBC (mean age: 67 years, 56% female, 90% white, breast 48%, prostate 32% and colorectal 21%), 22% had severe fatigue and 72% had 1+ issue/s on the EQ-5D-5L. Adhering to physical activity recommendations (odds ratio [OR] = 0.88, confidence interval [CI] = 0.77-0.99), meeting various dietary recommendations (fruit and vegetables OR = 0.79; CI = 0.68-0.91, free sugar OR = 0.85; CI = 0.76-0.96, fat OR = 0.71; CI = 0.62-0.82, red meat OR = 0.65; CI = 0.50-0.85) and not smoking (OR = 0.53, CI = 0.41-0.67) were associated with decreased odds of experiencing severe fatigue. Adhering to physical activity guidelines (OR = 0.71, CI = 0.62-0.82) was also associated with decreased odds of having 1+ QoL issue/s. CONCLUSIONS Adherence to various WCRF recommendations, particularly the recommendation for physical activity, was associated with less fatigue and better QoL in a large UK cohort of people living with and beyond breast, colorectal or prostate cancer. Multi-component interventions designed to support people LWBC to improve health behaviours, in line with the levels recommended by the WCRF, may also improve QoL.
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Affiliation(s)
- Fiona Kennedy
- Leeds Institute of Health Sciences, University of LeedsClarendon WayLeedsLS2 9NLUK
| | - Phillippa Lally
- Department of PsychologyUniversity of SurreyGuildfordSurreyGU2 7XHUK
| | - Natalie Ella Miller
- Behavioural Science and HealthUniversity College LondonGower StreetLondonWC1E 6BTUK
| | - Rana E. Conway
- Behavioural Science and HealthUniversity College LondonGower StreetLondonWC1E 6BTUK
| | - Anna Roberts
- Behavioural Science and HealthUniversity College LondonGower StreetLondonWC1E 6BTUK
| | - Helen Croker
- World Cancer Research Fund International140 Pentonville RoadLondonN1 9FWUK
| | - Abigail Fisher
- Behavioural Science and HealthUniversity College LondonGower StreetLondonWC1E 6BTUK
| | - Rebecca J. Beeken
- Leeds Institute of Health Sciences, University of LeedsClarendon WayLeedsLS2 9NLUK
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7
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Stone JY, Mayberry LS, Clouse K, Mulvaney S. The Role of Habit Formation and Automaticity in Diabetes Self-Management: Current Evidence and Future Applications. Curr Diab Rep 2023; 23:43-58. [PMID: 36749452 DOI: 10.1007/s11892-023-01499-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Diabetes is a chronic condition that requires consistent self-management for optimal health outcomes. People with diabetes are prone to burnout, cognitive burden, and sub-optimal performance of self-management tasks. Interventions that focus on habit formation have the potential to increase engagement by facilitating automaticity of self-management task performance. The purpose of this review is to (1) clarify the conceptualizations of habit formation and behavioral automaticity in the context of health behavior interventions, (2) review the evidence of habit in relation to behaviors relevant to diabetes self-management, and (3) discuss opportunities for incorporating habit formation and automaticity into diabetes self-management interventions. RECENT FINDINGS Modern habit research describes a habit as a behavior that results over time from an automatic mental process. Automatic behaviors are experienced as cue-dependent, goal-independent, unconscious, and efficient. Habit formation requires context-dependent repetition to form cue-behavior associations. Results of diabetes habit studies are mixed. Observational studies have shown positive associations between habit strength and target self-management behaviors such as taking medication and monitoring blood glucose, as well as glycemic outcomes such as HbA1c. However, intervention studies conducted in similar populations have not demonstrated a significant benefit of habit-forming interventions compared to controls, possibly due to varying techniques used to promote habit formation. Automaticity of self-management behaviors has the potential to minimize the burden associated with performance of self-management tasks and ultimately improve outcomes for people with diabetes. Future studies should focus on refining interventions focused on context-dependent repetition to promote habit formation and better measurement of habit automaticity in diabetes self-management.
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Affiliation(s)
- Jenine Y Stone
- Vanderbilt University, 461 21st Avenue South, Nashville, TN, 37240, USA.
- AMCR Institute, Escondido, CA, USA.
| | | | - Kate Clouse
- Vanderbilt University, 461 21st Avenue South, Nashville, TN, 37240, USA
| | - Shelagh Mulvaney
- Vanderbilt University, 461 21st Avenue South, Nashville, TN, 37240, USA
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8
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Watson S, McCrum LA, McGuinness B, Cardwell C, Clarke M, Woodside JV, McKenna G, McGowan L. Establishing Healthy Eating 'Habits': A Pilot Randomised Controlled Trial of a Habit-Based Dietary Intervention following Oral Rehabilitation for Older Adults. Nutrients 2023; 15:nu15030731. [PMID: 36771437 PMCID: PMC9919723 DOI: 10.3390/nu15030731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
An ageing population presents significant nutritional challenges, particularly for partially dentate adults. This two-armed pilot randomised controlled trial (RCT) compared habit formation (automaticity) for healthy eating behaviours between control and intervention groups after participation in a habit-based dietary intervention for older adults, following oral rehabilitation in the United Kingdom (UK). n = 54 participants were randomised to receive a habit-based dietary intervention (intervention group n = 27, IG) or standard dietary advice in a leaflet (control group n = 27, CG). The IG attended three sessions over six weeks, which focused on habit formation for three healthy eating behaviours (increasing fruit and vegetables, wholegrains, and healthy proteins). Participants were assessed for habit strength (using the Self-Report Behavioural Automaticity Index (SRBAI)) alongside health and nutrition outcomes at six weeks, four months and eight months. Forty-nine participants completed all follow-up visits. The IG compared to the CG had significant increases in automaticity at six weeks, four months (primary outcome) and eight months for eating ≥3 portions of fruit and vegetables; choosing wholegrain sources over white alternatives, and choosing healthy protein sources over red/processed meat. The mean change in the Mini Nutritional Assessment total score was greater in the IG compared with the CG at six weeks only (p = 0.03). A habit-based dietary intervention following oral rehabilitation increased automaticity for healthy dietary behaviours, which could translate into clinically meaningful benefits in this cohort of older adults.
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Affiliation(s)
- Sinead Watson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Leigh-Ann McCrum
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Bernadette McGuinness
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Christopher Cardwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Mike Clarke
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Jayne V. Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK
- Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Gerry McKenna
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Laura McGowan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK
- Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK
- Correspondence: ; Tel.: +44-2890-976401
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Chawner LR, Blundell-Birtill P, Hetherington MM. Parental intentions to implement vegetable feeding strategies at home: A cross sectional study. Appetite 2023; 181:106387. [PMID: 36427564 DOI: 10.1016/j.appet.2022.106387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/12/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
Abstract
In order to increase vegetable intake by children, parents are encouraged to implement strategies that promote trying and eating vegetables at mealtimes. Qualitative studies have previously highlighted barriers parents face in implementing healthy eating practices, such as time, monetary costs and child factors (e.g. fussy eaters). This study aimed to specify the relationships between child and parent factors and their effects on parental intentions to implement vegetable feeding strategies at mealtimes. Parental intentions to implement meal service (serving larger portions, offering variety, serving vegetables first) and experiential learning (repeated exposure, games, sensory play) strategies were examined. Parents (N = 302, 73 male, Mage = 33.5) also explained reasons why certain strategies may or may not work for their child (4-7y). For both types of strategy, higher food fussiness of the child predicted higher parental intentions to implement strategies at home. However, this was competitively mediated by low beliefs that the strategy would work for their child, resulting in weaker overall positive effects on intentions. In the meal service model, parental beliefs that healthy eating is important for their child had a positive, indirect effect on higher intentions, through involved parental feeding practices. However, this was not significant in the experiential learning strategies model. Written parental responses suggest that this may be due to meal service approaches being viewed as easier to implement, with little additional effort required. Increasing parental confidence to implement strategies successfully and managing expectations around successful outcomes of strategies (e.g. tasting, eating) may be important focuses of future interventions to support parents implementing vegetable feeding strategies at mealtimes.
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Affiliation(s)
- L R Chawner
- School of Psychology, University of Leeds, Leeds, West Yorkshire, UK.
| | | | - M M Hetherington
- School of Psychology, University of Leeds, Leeds, West Yorkshire, UK
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10
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Engels L, Mons C, Mergelsberg E, Kothe E, Hamilton K, Gardner B, ten Hoor G, Mullan B. How to improve the diet of toddlers? The feasibility of an online, habit-based intervention targeting parental feeding behaviour. Health Psychol Behav Med 2022; 10:1020-1037. [DOI: 10.1080/21642850.2022.2134869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Lisa Engels
- Department of Work & Social Psychology, Faculty of Psychology & Neurosciences, Maastricht University, Maastricht, Netherlands
| | - Carlotta Mons
- Department of Work & Social Psychology, Faculty of Psychology & Neurosciences, Maastricht University, Maastricht, Netherlands
| | - Enrique Mergelsberg
- Health Psychology and Behavioural Medicine Research Group, Faculty of Health Sciences, School of Psychology, Curtin University, Perth, Australia
| | - Emily Kothe
- Faculty of Health, School of Psychology, Deakin University, Burwood, Australia
| | - Kyra Hamilton
- Health Psychology and Behavioural Medicine Research Group, Faculty of Health Sciences, School of Psychology, Curtin University, Perth, Australia
- School of Applied Psychology, Griffith University, Nathan, Australia
| | | | - Gill ten Hoor
- Department of Work & Social Psychology, Faculty of Psychology & Neurosciences, Maastricht University, Maastricht, Netherlands
| | - Barbara Mullan
- Health Psychology and Behavioural Medicine Research Group, Faculty of Health Sciences, School of Psychology, Curtin University, Perth, Australia
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11
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Aronsen S, Conway R, Lally P, Roberts A, Croker H, Beeken RJ, Fisher A. Determinants of sleep quality in 5835 individuals living with and beyond breast, prostate, and colorectal cancer: a cross-sectional survey. J Cancer Surviv 2022; 16:1489-1501. [PMID: 34750779 DOI: 10.1007/s11764-021-01127-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The present study aimed to quantify the level of sleep problems in 5835 breast, prostate, and colorectal cancer survivors, and explore a number of potential determinants of poor sleep quality in the present sample. BMI, diet, and physical activity were of particular interest as potential determinants. METHODS Participants who completed the 'Health and Lifestyle after Cancer' survey were adults who had been diagnosed with breast, prostate, or colorectal cancer (mean time since cancer diagnosis was 35.5 months, SD=13.56). Sleep quality was assessed using the Pittsburgh Sleep Quality Index. BMI was calculated from self-reported height and weight. Participants were categorised as meeting/not meeting the World Cancer Research Fund (WCRF) recommendations for fibre, fruit and vegetables, added sugar, red meat, processed meat, fat, alcohol, and physical activity. Analyses accounted for demographic and clinical factors. RESULTS Fifty-seven percent of those with sleep data were classified as poor sleepers (response rate 79%). Being female, having a higher number of cancer treatments, more comorbid conditions, and being more anxious/depressed increased the odds of being a poor sleeper. After adjustment for these factors, there were no associations between diet/alcohol/physical activity and sleep. However, BMI was associated with sleep. Individuals in the overweight and obese categories had 22% and 79% higher odds of being poor sleepers than individuals in the underweight/healthy weight category, respectively. CONCLUSIONS The findings suggest that there may be a need to develop sleep quality interventions for cancer survivors with obesity. Even after adjustment for multiple clinical and demographic factors, BMI (particularly obesity) was associated with poor sleep. Thus, researchers and health professionals should find ways to support individuals with overweight and obesity to improve their sleep quality. IMPLICATIONS FOR CANCER SURVIVORS The present findings highlight that poor sleep is a common issue in cancer survivors. Interventions seeking to improve outcomes for cancer survivors over the longer term should consider sleep quality.
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Affiliation(s)
- Silje Aronsen
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Rana Conway
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Phillippa Lally
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Anna Roberts
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Helen Croker
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Rebecca J Beeken
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Abigail Fisher
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
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Factors Affecting Food Consumers’ Behavior during COVID-19 in Romania. Foods 2022; 11:foods11152275. [PMID: 35954042 PMCID: PMC9367920 DOI: 10.3390/foods11152275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
Crisis periods such as the COVID-19 pandemic may reshape consumers’ behavior and challenge all food chain actors on how to assure and better respond to consumers’ needs and wants. This study aimed to reveal the main concerns of consumers related to food consumption during the COVID-19 pandemic and to identify factors that may influence their behavior. An online survey was performed among 859 Romanian consumers. The Principal Component Analysis revealed five factors: ecofriendly, socio-economic aspects, food waste, plant-based food, and easily accessible food, which affected consumers’ food behavior during the COVID-19 pandemic. It was noticed that females tended to be more preoccupied with the socio-economic aspects and food waste components, compared to males. At the same time, older people were more concerned about the ecofriendly, socio-economic aspects and health concerns, compared with the younger group, the differences being statistically significant. These insights provide information on crucial aspects that shape consumers’ behavior during crisis periods.
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Gomes AI, Pereira AI, Guerreiro T, Branco D, Roberto MS, Pires A, Sousa J, Baranowski T, Barros L. SmartFeeding4Kids, an online self-guided parenting intervention to promote positive feeding practices and healthy diet in young children: study protocol for a randomized controlled trial. Trials 2021; 22:930. [PMID: 34922616 PMCID: PMC8683823 DOI: 10.1186/s13063-021-05897-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background Caregivers’ influence on young children’s eating behaviors is widely recognized. Nutritional interventions that focus on the promotion of children’s healthy diet should actively involve parents, focusing on their feeding behaviors and practices. Methods This work aims to describe the development and study protocol of the SmartFeeding4Kids (SF4K) program, an online self-guided 7-session intervention for parents of young (2–6 years old) children. The program is informed by social cognitive, self-regulation, and habit formation theoretical models and uses self-regulatory techniques as self-monitoring, goal setting, and feedback to promote behavior change. We propose to examine the intervention efficacy on children’s intake of fruit, vegetables, and added sugars, and parental feeding practices with a two-arm randomized controlled with four times repeated measures design (baseline, immediately, 3 and 6 months after intervention). Parental perceived barriers about food and feeding, food parenting self-efficacy, and motivation to change will be analyzed as secondary outcomes. The study of the predictors of parents’ dropout rates and the trajectories of parents’ and children’s outcomes are also objectives of this work. Discussion The SmartFeeding4Kids program relies on technological resources to deliver parents’ self-regulation techniques that proved effective in promoting health behaviors. The study design can enhance the knowledge about the most effective methodologies to change parental feeding practices and children’s food intake. As a self-guided online program, SmartFeeding4Kids might overcome parents’ attrition more effectively, besides being easy to disseminate and cost-effective. Trial registration The study was registered in ClinicalTrials.gov (NCT04591496) on October 19, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05897-z.
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Affiliation(s)
- Ana Isabel Gomes
- Faculty of Psychology, Research Center for Psychological Science (CICPSI), University of Lisbon, Alameda da Universidade, 1649-013, Lisbon, Portugal.
| | - Ana Isabel Pereira
- Faculty of Psychology, Research Center for Psychological Science (CICPSI), University of Lisbon, Alameda da Universidade, 1649-013, Lisbon, Portugal
| | - Tiago Guerreiro
- LASIGE, Faculty of Sciences, University of Lisbon, Campo Grande, 1749-016, Lisbon, Portugal
| | - Diogo Branco
- LASIGE, Faculty of Sciences, University of Lisbon, Campo Grande, 1749-016, Lisbon, Portugal
| | - Magda Sofia Roberto
- Faculty of Psychology, Research Center for Psychological Science (CICPSI), University of Lisbon, Alameda da Universidade, 1649-013, Lisbon, Portugal
| | - Ana Pires
- LASIGE, Faculty of Sciences, University of Lisbon, Campo Grande, 1749-016, Lisbon, Portugal
| | - Joana Sousa
- Lisbon School of Medicine, Nutrition Laboratory, University of Lisbon, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal
| | - Tom Baranowski
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Room 2038, Houston, TX, 77030-2600, USA
| | - Luísa Barros
- Faculty of Psychology, Research Center for Psychological Science (CICPSI), University of Lisbon, Alameda da Universidade, 1649-013, Lisbon, Portugal
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14
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Kang E, Kim S, Rhee YE, Yun YH. Development and validation of the Highly Effective Health Behavior Pattern Inventory - Short Form. Chronic Illn 2021; 17:81-94. [PMID: 30987434 DOI: 10.1177/1742395319843166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to develop and validate a short form (SF) of the highly effective health behavior pattern inventory (HEBPI) for chronic disease patients for comfort to use. METHODS HEBPI-SF is a self-reported questionnaire based on highly effective health behaviors associated with building healthy habits. HEBPI-SF was validated by calculating adjusted odds ratios (aOR) for the 12 HEBPI-SF health behavior subscales and the maintenance of the 12 corresponding health habits. RESULTS HEBPI-SF developed in this study comprised 12 subscales and 53 items, utilizing patient data (N = 724) derived from the original HEBPI (12 subscales and 131items). HEBPI-SF demonstrated high reliability (Cronbach's α of 0.703-0.859) and showed that the 12 health behaviors included in the HEBPI are associated with the maintenance of the corresponding health habits (aOR: 2.29-8.42). The scores of the HEBPI-SF showed a positive correlation with physical, mental, social, spiritual and general health status, quality of life, and self-management strategies. DISCUSSION HEBPI-SF is a reliable tool for the assessment of health behaviors of chronically ill patients. Considering previous findings of simple health behaviors significantly affecting health status, this survey tool for the assessment of health behaviors is useful for promotion and maintenance of healthy habits.
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Affiliation(s)
- Eunkyo Kang
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soojeong Kim
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ye E Rhee
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young H Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
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15
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Karssen LT, Vink JM, de Weerth C, Hermans RCJ, de Kort CPM, Kremers SP, Ruiter ELM, Larsen JK. An App-Based Parenting Program to Promote Healthy Energy Balance-Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework. JMIR Form Res 2021; 5:e24802. [PMID: 33988510 PMCID: PMC8164123 DOI: 10.2196/24802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/02/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The family environment plays an important role in the development of children's energy balance-related behaviors. As a result, parents' energy balance-related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP. OBJECTIVE This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance-related parenting practices among parents of children (aged 0-4 years) with a lower SEP. METHODS The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program. RESULTS In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance-related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2). CONCLUSIONS The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance-related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP. TRIAL REGISTRATION Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371.
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Affiliation(s)
- Levie T Karssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Jacqueline M Vink
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Roel C J Hermans
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
- Netherlands Nutrition Centre, The Hague, Netherlands
| | - Carina P M de Kort
- Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Stef Pj Kremers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Emilie L M Ruiter
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Junilla K Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
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16
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Adhikari P, Gollub E. Evaluation of the Small Changes, Healthy Habits Pilot Program: Its Influence on Healthy Eating and Physical Activity Behaviors of Adults in Louisiana. Eur J Investig Health Psychol Educ 2021; 11:251-262. [PMID: 34542462 PMCID: PMC8314334 DOI: 10.3390/ejihpe11010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 11/16/2022] Open
Abstract
The community-based Small Changes, Healthy Habits (SCHH) program was developed to teach skills and techniques to help adults in Louisiana make and maintain small behavioral changes in their food selection, preparation, and consumption, and in physical activity routines. The content of this four-week program included habit formation and goal setting techniques; physical activity guidance; strategies for a healthier home food environment; a grocery store tour focused on label reading for healthier food selections; basic knife and cooking skills. The program was piloted at ten sites throughout the state. A survey with 14 core items was applied before and after the program to evaluate participant acquisition of skills and behaviors associated with topic areas. A total of 47 participants provided complete data sets. Post-program, these participants reported increased confidence in preparing healthy meals at home (p = 0.04); changes in fats (p = 0.03) and salt (p = 0.01) intake; increased frequency of reading nutrition labels (32%); decreased frequency of meals eaten outside the home (Improvement Index = 0.27); and decreased time/day spent sitting (p < 0.05). These short-term results suggest that the SCHH program has potential to positively affect healthy eating and to reduce sedentary behaviors, both of which are fundamental to good health and wellness.
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Affiliation(s)
- Praja Adhikari
- Department of Nutrition, University of North Carolina, Greensboro, NC 27412, USA;
| | - Elizabeth Gollub
- School of Nutrition and Food Sciences, Louisiana State University Agricultural Center, Baton Rouge, LA 70803, USA
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17
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Judah G, Mullan B, Yee M, Johansson L, Allom V, Liddelow C. A Habit-Based Randomised Controlled Trial to Reduce Sugar-Sweetened Beverage Consumption: the Impact of the Substituted Beverage on Behaviour and Habit Strength. Int J Behav Med 2020; 27:623-635. [PMID: 32500393 DOI: 10.1007/s12529-020-09906-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Excess sugar consumption has been linked to numerous negative health outcomes, such as obesity and type II diabetes. Reducing sugar-sweetened beverage (SSB) consumption may reduce sugar intake and thus improve health. The aim of the study was to test the impact of the potentially different rewarding nature of water or diet drinks as replacements for SSB, using a habit and implementation intention-based intervention. METHOD An online randomised, two-arm parallel design was used. One hundred and fifty-eight participants (mainly from the UK and USA) who regularly consumed SSBs (Mage = 31.5, 51% female) were advised to create implementation intentions to substitute their SSB with either water or a diet drink. Measures of SSB consumption, habit strength and hedonic liking were taken at baseline and at 2 months. Water or diet drink consumption was only measured at 2 months. RESULTS There was a large and significant reduction in SSB consumption and self-reported SSB habits for both the water and diet drink groups, but no difference between groups. There were no differences in hedonic liking for the alternative drink, alternative drink consumption and alternative drink habit between the two groups. Reduction in SSB hedonic liking was associated with reduced SSB consumption and habit. CONCLUSION This study demonstrates that an implementation intention-based intervention achieved substantial reductions in SSB consumption and habits. It also indicates that hedonic liking for SSBs and alternative drinks are associated with changes in consumption behaviour. Substituting SSBs with water or diet drinks was equally as effective in reducing SSB consumption.
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Affiliation(s)
- Gaby Judah
- Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Barbara Mullan
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Kent Street, Bentley, WA, 6102, Australia.
| | - Monica Yee
- Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Lina Johansson
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Vanessa Allom
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Caitlin Liddelow
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Kent Street, Bentley, WA, 6102, Australia
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18
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Black MM, Trude ACB, Lutter CK. All Children Thrive: Integration of Nutrition and Early Childhood Development. Annu Rev Nutr 2020; 40:375-406. [PMID: 32966185 DOI: 10.1146/annurev-nutr-120219-023757] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Building on the successes of child survival, we review the evidence needed to ensure both that children who survive also thrive and that recommendations promote equity, with no child left behind. To illustrate the critical roles played by nutrition and child development, we revise the Conceptual Framework for the Causes of Malnutrition and Death and the Nurturing Care Framework to create the Conceptual Framework of All Children Surviving and Thriving. The revised framework highlights the goals of child growth and development, supported by health, nutrition, learning, responsive caregiving, and security and safety. We review the challenges posed by undernutrition, stunting, micronutrient deficiencies, overweight, and children not reaching their developmental potential. Although integrated nutrition-childhood development interventions have shown promising effects, most have not been implemented at scale. Implementation science that investigates how and why integrated interventions work in real life, along with the acceptability, feasibility, cost, coverage, and sustainability of the interventions, is needed to ensure equity for all children thriving.
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Affiliation(s)
- Maureen M Black
- RTI International, Research Triangle Park, North Carolina 27709, USA.,Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA;
| | - Angela C B Trude
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA;
| | - Chessa K Lutter
- RTI International, Research Triangle Park, North Carolina 27709, USA.,Department of Family Science, University of Maryland School of Public Health, College Park, Maryland 20742, USA
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19
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Oral hygiene behaviour automaticity: Are toothbrushing and interdental cleaning habitual behaviours? J Dent 2020; 102:103470. [PMID: 32916230 DOI: 10.1016/j.jdent.2020.103470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Toothbrushing and interdental cleaning are critical to maintaining good oral health. Literature is beginning to suggest that these behaviours may be conducted automatically, although the instigation ('deciding to do') and execution ('doing') of these behaviours has never been examined separately. The objective of this study was to test a theoretically informed supposition that oral hygiene behaviours in adults are automatic behaviours. METHODS One hundred and fifty participants attending three types of dental providers covering emergency and routine dental services, completed a questionnaire. The self-reported behavioural automaticity index scale (SRBAI) was used to measure behavioural automaticity. RESULTS Morning toothbrushing SRBAI scores were higher than evening scores (Z=-3.315, p = 0.001). Automaticity scores for instigating both toothbrushing and interdental cleaning were also higher compared to execution (toothbrushing: Z=-2.601, p = 0.009 and interdental cleaning: Z=-2.256. p = 0.024). Toothbrushing automaticity scores were associated with age, gender and self-efficacy, whereas interdental cleaning automaticity scores were associated with intention. Individuals in lower socio-economic status (SES) occupations had significantly higher automaticity scores for interdental cleaning compared to those with higher SES roles. CONCLUSIONS A high proportion of people undertake toothbrushing and interdental cleaning automatically, especially in relation to embarking on these behaviours. This is most pronounced in morning toothbrushing. CLINICAL SIGNIFICANCE Promoting improvements in oral hygiene behaviour toothbrushing and interdental cleaning are key strategies in preventing caries and periodontal disease. A greater understanding of what prompts and sustains these behaviours helps inform how behaviour change efforts should be approached.
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McCrum LA, Watson S, McGowan L, McGuinness B, Cardwell C, Clarke M, Woodside JV, McKenna G. Development and feasibility of a tailored habit-based dietary intervention coupled with natural tooth replacement on the nutritional status of older patients. Pilot Feasibility Stud 2020; 6:120. [PMID: 32855815 PMCID: PMC7446197 DOI: 10.1186/s40814-020-00654-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults suffering partial tooth loss may need additional intervention strategies other than natural tooth replacement alone to improve their nutritional status. This study aimed to design and develop a habit-based tailored dietary intervention and to assess the feasibility and acceptability of the intervention, in conjunction with natural tooth replacement, amongst partially dentate older adults. METHODS The design and development of the dietary intervention (phase 1) consisted of analysis of the target population's dietary intake and qualitative research through focus groups with community-dwelling older adults (aged 65 years and over). The dietary intervention consisted of forming three healthy dietary habits around fruits and vegetables, wholegrains and healthy proteins. Feasibility of the intervention was then tested amongst older adults who had recently completed dental treatment for natural tooth replacement in a small non-randomised single arm study (phase 2). The principal feasibility outcome was the usability and acceptability of the intervention which was measured using evaluation questionnaires and by conducting post-intervention semi-structured interviews. Supporting outcomes consisted of feasibility of screening procedures, recruitment strategies and retention/attrition rates as well as the participant's compliance to the intervention assessed through self-monitoring tracking sheets. RESULTS Twenty-one older adults (mean [SD] age 72.1 [10.4].) took part in one of four focus group discussions (phase 1). Twelve themes related to barriers (e.g. oral health, appetite) and facilitators (e.g. nutritional knowledge, retirement) of healthy eating guided intervention development, as did a further five themes when asked for direct intervention feedback. Nine older adult participants (mean [SD] age 72.5[9.7]) were recruited into the feasibility study (phase 2) where eight themes were identified from feedback interview discussions. The principal outcome measures identified intervention feasibility as participants considered the intervention acceptable and useable as both the evaluation questionnaire and qualitative interview results were overwhelmingly positive. As a supporting outcome measure, strong intervention compliance was also achieved. Screening procedures were accepted but additional recruitment strategies (e.g. incorporation of home study visits or recruitment via posters advertisement) may benefit future study enrolment and retention. CONCLUSION Phase 1 and phase 2 findings have allowed for an iterative, user-driven intervention to be developed and refined for a randomised control study to evaluate the intervention's effectiveness. TRIAL REGISTRATION ISRCTN66118345.
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Affiliation(s)
- Leigh-Ann McCrum
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
| | - Sinead Watson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
| | - Laura McGowan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
- Institute for Global Food Security, Queen’s University Belfast, Belfast, BT9 5BN UK
| | - Bernadette McGuinness
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
| | - Christopher Cardwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
| | - Mike Clarke
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
| | - Jayne V. Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
- Institute for Global Food Security, Queen’s University Belfast, Belfast, BT9 5BN UK
| | - Gerry McKenna
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
- Centre for Dentistry, Queen’s University Belfast, Belfast, BT12 6BP UK
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21
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Franse CB, Boelens M, Fries LR, Constant F, van Grieken A, Raat H. Interventions to increase the consumption of water among children: A systematic review and meta-analysis. Obes Rev 2020; 21:e13015. [PMID: 32167233 PMCID: PMC7317453 DOI: 10.1111/obr.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 12/17/2022]
Abstract
The aim of this study was to conduct a systematic review and meta-analysis on the effectiveness of interventions to increase children's water consumption. A systematic literature search was conducted in seven electronic databases. Studies published in English before 18 February 2019 that evaluated any type of intervention that measured change in water consumption among children aged 2 to 12 years by applying any type of design were included. Of the 47 interventions included in the systematic review, 24 reported a statistically significant increase in water consumption. Twenty-four interventions (17 randomized controlled trials and seven studies with other controlled designs) were included in the meta-analysis. On average, children in intervention groups consumed 29 mL/d (confidence interval [CI] = 13-46 mL/d) more water than did children in control groups. This effect was larger in eight interventions focused specifically on diet (MD = 73 mL/d, CI = 20-126 mL/d) than in 16 interventions focused also on other lifestyle factors (MD = 15 mL/d, CI = 1-29 mL/d). Significant subgroup differences were also found by study setting and socioecological level targeted but not by children's age group, intervention strategy, or study design. In conclusion, there is evidence that, on average, lifestyle interventions can lead to small increases in children's daily water consumption. More research is needed to further understand the specific intervention elements that have the greatest effect.
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Affiliation(s)
- Carmen B. Franse
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Mirte Boelens
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | | | | | - Amy van Grieken
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Hein Raat
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
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Muchira JM, Gona PN, Mogos MF, Stuart‐Shor E, Leveille SG, Piano MR, Hayman LL. Temporal Trends and Familial Clustering of Ideal Cardiovascular Health in Parents and Offspring Over the Life Course: An Investigation Using The Framingham Heart Study. J Am Heart Assoc 2020; 9:e016292. [PMID: 32486880 PMCID: PMC7429037 DOI: 10.1161/jaha.120.016292] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Evidence suggests familial aggregation and intergenerational associations for individual cardiovascular health (CVH) metrics. Over a 53‐year life course, we examined trends and association of CVH between parents and their offspring at similar mean ages. Methods and Results We conducted a series of cross‐sectional analyses of the FHS (Framingham Heart Study). Parent‐offspring pairs were assessed at exams where their mean age distributions were similar. Ideal CVH was defined using 5 CVH metrics: blood pressure (<120/<80 mm Hg), fasting blood glucose (<100 mg/dL), blood cholesterol (<200 mg/dL), body mass index (<25 kg/m2), and non‐smoking. Joinpoint regression and Chi‐squared test were used to assess linear trend; proportional‐odds regression was used to examine the association between parents and offspring CVH. A total of 2637 parents were paired with 3119 biological offspring throughout 6 exam cycles. Similar patterns of declining ideal CVH with advancing age were observed in parents and offspring. Small proportions of parents (4%) and offspring (17%) achieved 5 CVH metrics at ideal levels (P‐trend <0.001). Offspring of parents with poor CVH had more than twice the odds of having poor CVH (pooled odds ratio, 2.59; 95% CI, 1.98–3.40). Over time, elevated glucose levels and obesity doubled among the offspring and were the main drivers for declining ideal CVH trends. Conclusions Parental CVH was positively associated with offspring CVH. However, intergenerational CVH gains from declining smoking rates, cholesterol, and blood pressure were offset by rising offspring obesity and elevated glucose levels. This suggests an intergenerational phenotypic shift of risk factors and the need for a family‐centered approach to cardiovascular care.
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Affiliation(s)
- James M. Muchira
- Center for Research Development and ScholarshipVanderbilt University, School of NursingNashvilleTN
- College of Nursing and Health SciencesUniversity of Massachusetts BostonBostonMA
| | - Philimon N. Gona
- College of Nursing and Health SciencesUniversity of Massachusetts BostonBostonMA
| | - Mulubrhan F. Mogos
- Center for Research Development and ScholarshipVanderbilt University, School of NursingNashvilleTN
| | - Eileen Stuart‐Shor
- College of Nursing and Health SciencesUniversity of Massachusetts BostonBostonMA
- Beth Israel Deaconess Medical CenterBostonMA
| | - Suzanne G. Leveille
- College of Nursing and Health SciencesUniversity of Massachusetts BostonBostonMA
- Beth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
| | - Mariann R. Piano
- Center for Research Development and ScholarshipVanderbilt University, School of NursingNashvilleTN
| | - Laura L. Hayman
- College of Nursing and Health SciencesUniversity of Massachusetts BostonBostonMA
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23
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Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
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24
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Stuber JM, Mackenbach JD, de Boer FE, de Bruijn GJ, Gillebaart M, Harbers MC, Hoenink JC, Klein MCA, Middel CNH, van der Schouw YT, Schuitmaker-Warnaar TJ, Velema E, Vos AL, Waterlander WE, Lakerveld J, Beulens JWJ. Reducing cardiometabolic risk in adults with a low socioeconomic position: protocol of the Supreme Nudge parallel cluster-randomised controlled supermarket trial. Nutr J 2020; 19:46. [PMID: 32429917 PMCID: PMC7236937 DOI: 10.1186/s12937-020-00562-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/05/2020] [Indexed: 12/17/2022] Open
Abstract
Background Unhealthy lifestyle behaviours such as unhealthy dietary intake and insufficient physical activity (PA) tend to cluster in adults with a low socioeconomic position (SEP), putting them at high cardiometabolic disease risk. Educational approaches aiming to improve lifestyle behaviours show limited effect in this population. Using environmental and context-specific interventions may create opportunities for sustainable behaviour change. In this study protocol, we describe the design of a real-life supermarket trial combining nudging, pricing and a mobile PA app with the aim to improve lifestyle behaviours and lower cardiometabolic disease risk in adults with a low SEP. Methods The Supreme Nudge trial includes nudging and pricing strategies cluster-randomised on the supermarket level, with: i) control group receiving no intervention; ii) group 1 receiving healthy food nudges (e.g., product placement or promotion); iii) group 2 receiving nudges and pricing strategies (taxing of unhealthy foods and subsidizing healthy foods). In collaboration with a Dutch supermarket chain we will select nine stores located in low SEP neighbourhoods, with the nearest competitor store at > 1 km distance and managed by a committed store manager. Across the clusters, a personalized mobile coaching app targeting walking behaviour will be randomised at the individual level, with: i) control group; ii) a group receiving the mobile PA app. All participants (target n = 1485) should be Dutch-speaking, aged 45–75 years with a low SEP and purchase more than half of their household grocery shopping at the selected supermarkets. Participants will be recruited via advertisements and mail-invitations followed by community-outreach methods. Primary outcomes are changes in systolic blood pressure, LDL-cholesterol, HbA1c and dietary intake after 12 months follow-up. Secondary outcomes are changes in diastolic blood pressure, blood lipid markers, waist circumference, steps per day, and behavioural factors including healthy food purchasing, food decision style, social cognitive factors related to nudges and to walking behaviours and customer satisfaction after 12 months follow-up. The trial will be reflexively monitored to support current and future implementation. Discussion The findings can guide future research and public health policies on reducing lifestyle-related health inequalities, and contribute to a supermarket-based health promotion intervention implementation roadmap. Trial registration Dutch Trial Register ID NL7064, 30th of May, 2018
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Affiliation(s)
- Josine M Stuber
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands. .,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.
| | - Joreintje D Mackenbach
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Femke E de Boer
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, the Netherlands
| | - Gert-Jan de Bruijn
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Marleen Gillebaart
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, the Netherlands
| | - Marjolein C Harbers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jody C Hoenink
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Michel C A Klein
- Social AI group, department of Computer Science, VU University Amsterdam, Amsterdam, the Netherlands
| | - Cédric N H Middel
- Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Elizabeth Velema
- Netherlands Nutrition Centre (Voedingscentrum), The Hague, The Netherlands
| | - Anne L Vos
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Wilma E Waterlander
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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25
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Piao M, Ryu H, Lee H, Kim J. Use of the Healthy Lifestyle Coaching Chatbot App to Promote Stair-Climbing Habits Among Office Workers: Exploratory Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e15085. [PMID: 32427114 PMCID: PMC7267999 DOI: 10.2196/15085] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/13/2019] [Accepted: 02/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background Lack of time for exercise is common among office workers given their busy lives. Because of occupational restrictions and difficulty in taking time off, it is necessary to suggest effective ways for workers to exercise regularly. Sustaining lifestyle habits that increase nonexercise activity in daily life can solve the issue of lack of exercise time. Healthy Lifestyle Coaching Chatbot is a messenger app based on the habit formation model that can be used as a tool to provide a health behavior intervention that emphasizes the importance of sustainability and involvement. Objective This study aimed to assess the efficacy of the Healthy Lifestyle Coaching Chatbot intervention presented via a messenger app aimed at stair-climbing habit formation for office workers. Methods From February 1, 2018, to April 30, 2018, a total of 106 people participated in the trial after online recruitment. Participants were randomly assigned to the intervention group (n=57) or the control group (n=49). The intervention group received cues and intrinsic and extrinsic rewards for the entire 12 weeks. However, the control group did not receive intrinsic rewards for the first 4 weeks and only received all rewards as in the intervention group from the fifth to twelfth week. The Self-Report Habit Index (SRHI) of participants was evaluated every week, and the level of physical activity was measured at the beginning and end of the trial. SPSS Statistics version 21 (IBM Corp) was used for statistical analysis. Results After 4 weeks of intervention without providing the intrinsic rewards in the control group, the change in SRHI scores was 13.54 (SD 14.99) in the intervention group and 6.42 (SD 9.42) in the control group, indicating a significant difference between the groups (P=.04). When all rewards were given to both groups, from the fifth to twelfth week, the change in SRHI scores of the intervention and control groups was comparable at 12.08 (SD 10.87) and 15.88 (SD 13.29), respectively (P=.21). However, the level of physical activity showed a significant difference between the groups after 12 weeks of intervention (P=.045). Conclusions This study provides evidence that intrinsic rewards are important to enhance the sustainability and effectiveness of an intervention. The Healthy Lifestyle Coaching Chatbot program can be a cost-effective method for healthy habit formation. Trial Registration Clinical Research Information Service KCT0004009; https://tinyurl.com/w4oo7md
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Affiliation(s)
- Meihua Piao
- Office of Hospital Information, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeongju Ryu
- College of Nursing, Seoul National University, Jongno-gu, Republic of Korea
| | - Hyeongsuk Lee
- College of Nursing, Gachon University, Incheon, Republic of Korea
| | - Jeongeun Kim
- College of Nursing, Seoul National University, Jongno-gu, Republic of Korea.,Interdisciplinary Program of Medical Informatics, Seoul National University, Seoul, Republic of Korea.,Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
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26
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Folta SC, Anzman-Frasca S, Tsai M, Johnson SK, Rossi M, Cash SB. Snack It Up for Parents: Brief Videos and Tip Sheets for Promoting Vegetable Snacks to School-Aged Children. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:565-567. [PMID: 31917130 DOI: 10.1016/j.jneb.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY
| | | | | | | | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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27
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Davis L, Walsh BT, Schebendach J, Glasofer DR, Steinglass JE. Habits are stronger with longer duration of illness and greater severity in anorexia nervosa. Int J Eat Disord 2020; 53:413-419. [PMID: 32227516 PMCID: PMC7217727 DOI: 10.1002/eat.23265] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between habit strength and clinical features of anorexia nervosa (AN). Habit strength, separate from intention, relates to the persistence of behavior, and is measured by the Self-Report Habit Index (SRHI). We hypothesized that habit strength would be greater among individuals with AN than healthy controls (HC) and that habit strength would be associated with duration and severity of illness. METHOD Participants were 116 women with AN (n = 69) and HC (n = 47) who completed the SRHI, the Eating Disorder Examination-Questionnaire (EDE-Q), and a multi-item laboratory meal. The SRHI assessed four domains and these subscales were averaged for the total score. RESULTS Individuals with AN demonstrated significantly greater habit strength than HC in the total score (t114 = 7.00, p < .01), and within each domain (restrictive eating, compensatory behavior, delay of eating, and rituals). Total SRHI score was significantly associated with EDE-Q scores for both AN and HC groups (rAN = .59, pAN = <.001; rHC = .32, pHC = .030). Among patients, there was a significant association between SRHI and duration of illness (r = .38, p = .001). There was no significant association between SRHI and caloric intake (rAN = -.20, pAN = .10; rHC = -.25, pHC = .09). DISCUSSION Habit strength was related to chronicity and severity of AN, suggesting that habit formation may play an important role in illness. These data suggest avenues for mechanism research and treatment development.
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Affiliation(s)
- Lauren Davis
- Department of PsychiatryColumbia University Irving Medical Center & New York State Psychiatric Institute New York New York USA
| | - B. Timothy Walsh
- Department of PsychiatryColumbia University Irving Medical Center & New York State Psychiatric Institute New York New York USA
| | - Janet Schebendach
- Department of PsychiatryColumbia University Irving Medical Center & New York State Psychiatric Institute New York New York USA
| | - Deborah R. Glasofer
- Department of PsychiatryColumbia University Irving Medical Center & New York State Psychiatric Institute New York New York USA
| | - Joanna E. Steinglass
- Department of PsychiatryColumbia University Irving Medical Center & New York State Psychiatric Institute New York New York USA
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28
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Landgren K, Quaye AA, Hallström E, Tiberg I. Family-based prevention of overweight and obesity in children aged 2–6 years: a systematic review and narrative analysis of randomized controlled trials. CHILD AND ADOLESCENT OBESITY 2020. [DOI: 10.1080/2574254x.2020.1752596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Kajsa Landgren
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Angela A. Quaye
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Elinor Hallström
- Research Institute of Sweden, Department of Agriculture and Food, Lund, Sweden
| | - Irén Tiberg
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
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29
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Hodder RK, O'Brien KM, Stacey FG, Tzelepis F, Wyse RJ, Bartlem KM, Sutherland R, James EL, Barnes C, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2019; 2019:CD008552. [PMID: 31697869 PMCID: PMC6837849 DOI: 10.1002/14651858.cd008552.pub6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Fiona G Stacey
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
- University of NewcastlePriority Research Centre in Physical Activity and NutritionCallaghanAustralia
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanNew South WalesAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Erica L James
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Luke Wolfenden
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
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Fritz H, Hu YL, Gahman K, Almacen C, Ottolini J. Intervention to Modify Habits: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2019; 40:99-112. [PMID: 31642394 DOI: 10.1177/1539449219876877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intervening to change clients' habits in the course of their everyday occupations could improve health. Habit formation interventions are an emerging area of science, however, and there is a need to better understand the current state of habit intervention research. The objective of this study is to examine the evidence related to habit formation interventions to modify health habits among adults. We performed a scoping review of peer-review articles published since January 1, 2008. The majority of the 18 studies included in the review were randomized control trials using one of two measures to assess habit change. Studies targeted a range of habits. Trial results were mixed but supportive of habit formation approaches. Through habit formation interventions, a range of everyday behaviors can become a habit. Occupational therapy professionals can use data and results generated from this review to inform the development of occupation-based habit formation treatments.
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Affiliation(s)
| | - Yi-Ling Hu
- Wayne State University, Detroit, MI, USA
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Touyz LM, Wakefield CE, Grech AM, Quinn VF, Costa DSJ, Zhang FF, Cohn RJ, Sajeev M, Cohen J. Parent-targeted home-based interventions for increasing fruit and vegetable intake in children: a systematic review and meta-analysis. Nutr Rev 2019; 76:154-173. [PMID: 29319789 DOI: 10.1093/nutrit/nux066] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Context Parent interventions delivered in the home represent a valuable approach to improving children's diets. Objective This review aims to examine the effectiveness of parent-targeted in-home interventions in increasing fruit and vegetable intake in children. Data Sources Five electronic databases were searched: MEDLINE, Embase, PubMed, CINAHL, and PsycINFO. Study Selection Randomized and nonrandomized trials conducted in children aged 2 to 12 years and published in English from 2000 to 2016 were eligible. Data Extraction Eighteen publications were reviewed, and 12 randomized trials were analyzed. Studies were pooled on the basis of outcome measure and type of intervention, resulting in 3 separate meta-analyses. Results Nutrition education interventions resulted in a small but significant increase in fruit intake (Hedges' g = 0.112; P = 0.028). Taste exposure interventions led to a significant increase in vegetable intake, with a moderate effect (Hedges' g = 0.438; P < 0.001). Interventions involving daily or weekly sessions reported positive outcomes more frequently than those using monthly sessions. Conclusions Future interventions should incorporate regular taste exposure to maximize increases in vegetable intake in children. This is particularly important because fewer children meet national recommendations for vegetable intake than for fruit intake.
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Affiliation(s)
- Lauren M Touyz
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Allison M Grech
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Veronica F Quinn
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Fang Fang Zhang
- Department of Nutrition Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Richard J Cohn
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Mona Sajeev
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Jennifer Cohen
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Department of Nutrition and Dietetics, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Cleo G, Beller E, Glasziou P, Isenring E, Thomas R. Efficacy of habit-based weight loss interventions: a systematic review and meta-analysis. J Behav Med 2019; 43:519-532. [DOI: 10.1007/s10865-019-00100-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
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Cradock AL, Poole MK, Agnew KE, Flax C, Plank K, Capdarest-Arest N, Patel AI. A systematic review of strategies to increase drinking-water access and consumption among 0- to 5-year-olds. Obes Rev 2019; 20:1262-1286. [PMID: 31250960 DOI: 10.1111/obr.12833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/10/2018] [Accepted: 12/27/2018] [Indexed: 12/12/2022]
Abstract
The objective of this study is to identify promising strategies for improving drinking-water access and consumption among children aged 0 to 5 years. MEDLINE/PubMed, Embase, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched in this review. Studies included peer-reviewed, full-text studies from high-income countries, published in English between January 1, 2000, and January 12, 2018, that evaluated interventions to increase water access or consumption in children aged 0 to 5 years. Twenty-five studies met inclusion criteria; 19 used an effective intervention strategy to increase water access or water consumption. Three studies addressed both water access and consumption. Frequently used strategies included policy and practice changes, increasing water access and convenience, and education, training, or social support for caregivers. Studies were of fair methodological quality (average score: 18.8 of 26) for randomized studies and of moderate quality (5.1 of 9) for non-randomized studies. To date, few high-quality studies with objectively measured outcomes have clearly demonstrated strategies that may influence water intake and consumption among young children aged 0 to 5 years.
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Affiliation(s)
- Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary Kathryn Poole
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kaylan E Agnew
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Chasmine Flax
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kaela Plank
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA, USA
| | | | - Anisha I Patel
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Department of Pediatrics, Stanford University, Stanford, CA, USA
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Millen L, Overcash F, Vickers Z, Reicks M. Implementation of Parental Strategies to Improve Child Vegetable Intake: Barriers and Facilitators. Glob Pediatr Health 2019; 6:2333794X19855292. [PMID: 31236434 PMCID: PMC6572880 DOI: 10.1177/2333794x19855292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose. To qualitatively assess barriers and facilitators to implementing specific behavioral strategies to increase child vegetable intake during home dinner meals by low-income parents. Method. Parents (n = 49) of children (9-12 years) were asked to implement 1 behavioral strategy following each of 6 weekly cooking classes at community centers. Example strategies included serving vegetables first, serving 2 vegetables, and using a bigger spoon to serve vegetables. The following week, parents discussed how they used the strategy and barriers and facilitators to its use. Discussions were recorded, transcribed verbatim, and coded separately by strategy using NVivo Pro 11 software. Inductive, comparative thematic analyses were used to identify themes by strategy. Results. Most participants were multiethnic women aged 30 to 39 years with low food security. Time and scheduling conflicts limited involvement of children in vegetable preparation (Child Help strategy). The type of foods served and an unfamiliar serving style inhibited use of the MyPlate and Available/Visible strategies, respectively. Children's dislike of vegetables limited use of the Serve Vegetables First and Serve 2 Vegetables strategies. Ease of use promoted use of the Bigger Spoon strategy. Conclusion. Educators could tailor application of specific parent strategies for low-income families based on child and environmental characteristics.
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McKee M, Mullan B, Mergelsberg E, Gardner B, Hamilton K, Slabbert A, Kothe E. Predicting what mothers feed their preschoolers: Guided by an extended theory of planned behaviour. Appetite 2019; 137:250-258. [DOI: 10.1016/j.appet.2019.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/17/2022]
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Snuggs S, Houston-Price C, Harvey K. Healthy eating interventions delivered in the family home: A systematic review. Appetite 2019; 140:114-133. [PMID: 31091432 DOI: 10.1016/j.appet.2019.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 12/13/2022]
Abstract
Unhealthy eating habits have long term health implications and can begin at a young age when children still consume the majority of their meals at home. As parents are the principal agents of change in children's eating behaviours, the home environment is the logical location for the delivery of interventions targeting healthy family eating. Despite the recent proliferation of published studies of behaviour-change interventions delivered in the home, there has been little attempt to evaluate what makes such interventions successful. This review provides a systematic evaluation of all healthy eating interventions delivered to families in the home environment to date and seeks to identify the successful elements of these interventions and make recommendations for future work. Thirty nine studies are described, evaluated and synthesised. Results show that evidence- and theory-based interventions tended to be more successful than those that did not report detailed formative or evaluative work although details of theory application were often lacking. Careful analysis of the results did not show any further systematic similarities shared by successful interventions. Recommendations include the need for more clearly theoretically driven interventions, consistent approaches to measuring outcomes and clarity regarding target populations and desired outcomes.
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Affiliation(s)
- Sarah Snuggs
- School of Psychology and Clinical Language Sciences, University of Reading, RG6 7BE, UK
| | - Carmel Houston-Price
- School of Psychology and Clinical Language Sciences, University of Reading, RG6 7BE, UK
| | - Kate Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, RG6 7BE, UK.
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Phillips LA, Johnson M, More KR. Experimental test of a planning intervention for forming a 'higher order' health-habit. Psychol Health 2019; 34:1328-1346. [PMID: 31012741 DOI: 10.1080/08870446.2019.1604956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Habit-formation interventions may help individuals initiate and maintain behaviour change. This paper proposes and empirically tests the idea that it is possible for individuals to form 'higher-order habits', or behaviours that can be executed in more than one way, and still be habitual. Design: Participants (N = 82) were healthy adults randomly assigned to an action-and-coping-planning intervention for forming a 'higher-order habit' of filling half of their dinner plates with fruits and vegetables or a control condition. Key measures were collected at baseline and 1, 2 and 3 weeks post-baseline. Participants submitted 3 pictures per week of their dinner plates via snapchat/email. Main Outcome Measures: Intrinsic motivation, habit strength and behavioural frequency for filling half their dinner plates with fruits and vegetables. Results: Intervention participants reported significantly greater habit strength at each follow-up time point. Controls did show some degree of habit formation, despite not fully forming a habit. Behavioural automaticity increased despite consuming a variety of fruits/vegetables; results did not depend on participants' intrinsic motivation to consume fruits/vegetables. Conclusion: It may be possible for individuals to form 'higher-order' habits, which may be particularly important in health contexts, in which many target behaviours are complex and can be seen as higher-order.
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Affiliation(s)
| | - Madeline Johnson
- Department of Psychology, Iowa State University , Ames , Iowa , USA
| | - Kimberly R More
- Department of Psychology, Iowa State University , Ames , Iowa , USA
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Fritz H, Tarraf W, Brody A, Levy P. Feasibility of a behavioral automaticity intervention among African Americans at risk for metabolic syndrome. BMC Public Health 2019; 19:413. [PMID: 30991972 PMCID: PMC6469067 DOI: 10.1186/s12889-019-6675-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 03/19/2019] [Indexed: 12/02/2022] Open
Abstract
Background Targeting habit-development (behavioral automaticity) as part of healthy lifestyle behavior change interventions may improve the adoption and maintenance of healthful behaviors. Few studies, however, have evaluated the feasibility of using a habit-development approach to foster the adoption of recommended physical activity and dietary behaviors. We report quantitative and qualitative data from a feasibility study evaluating a habit-formation intervention to foster healthy dietary and physical activity habits among middle aged African Americans with metabolic syndrome. Methods Using a non-comparative design we evaluated the feasibility an 8-week, hybrid format (telecoaching and face-to-face sessions), habit-focused intervention targeting the development of healthful dietary and physical activity habit development among 24 African Americans aged 40 and older with metabolic syndrome recruited from the emergency department – a setting where individuals in under-resourced communities often go for primary care. We administered behavioral automaticity measures tailored to participants’ self-selected habits biweekly during the intervention and collected clinical outcomes of systolic blood pressure, weight, waist circumference, and BMI at baseline week 20. Results Participant attrition from the program was high (~ 50%). Despite high levels of attrition, 92% of intervention completers were extremely satisfied with the program. Intervention completers also experienced gains in behavioral automaticity for both dietary and physical activity habits. Overall, higher levels of adherence were associated with higher positive gains in automaticity with the statistical significance of the associations being more pronounced for physical activity habit plans relative to dietary habit plans. Conclusions Our preliminary data support a habit-development approach for fostering the adoption of healthful dietary and physical activity habits. However, in this pilot study high rates of attrition were seen, suggesting that strategies to improve retention and participant engagement should be included in future studies, particularly when targeting African American emergency department patients. Trial registration ClinicalTrials.gov ID: NCT03370419 Registered 12/11/2017, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12889-019-6675-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heather Fritz
- Eugene Applebaum College of Pharmacy and Health Sciences, Occupational Therapy Program, Wayne State University, Detroit, Michigan, 48201, USA. .,Institute of Gerontology, Wayne State University, Detroit, Michigan, 48202, USA.
| | - Wassim Tarraf
- Eugene Applebaum College of Pharmacy and Health Sciences, Occupational Therapy Program, Wayne State University, Detroit, Michigan, 48201, USA.,Institute of Gerontology, Wayne State University, Detroit, Michigan, 48202, USA
| | - Aaron Brody
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, 48201, USA
| | - Philip Levy
- Department of Emergency Medicine and Assistant Vice President for Translational Science and Clinical Research Innovation, Wayne State University, Detroit, Michigan, 48201, USA
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Kliemann N, Croker H, Johnson F, Beeken RJ. Starting university with high eating self-regulatory skills protects students against unhealthy dietary intake and substantial weight gain over 6 months. Eat Behav 2018; 31:105-112. [PMID: 30243053 PMCID: PMC6234330 DOI: 10.1016/j.eatbeh.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 08/10/2018] [Accepted: 09/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is consistent evidence that suggests first year students are at risk of weight gain, but the reasons for this vulnerability are still unclear. This study aimed to explore whether the ability to regulate eating behaviours is a predictor of weight and dietary changes in first year undergraduate students. METHODS First year undergraduate students from universities situated in London were invited to complete a survey at the beginning of the academic year and at 6-month follow-up. Each survey included the Self-Regulation of Eating Behaviour Questionnaire, food frequency questions, socio-demographic questions and anthropometric questions. Linear and logistic regressions were performed to explore the associations between baseline eating self-regulatory skills and weight and dietary changes. RESULTS 481 first year undergraduate students took part in the study. Students who entered university with higher eating self-regulatory skills were more likely to maintain or achieve a higher fruit and vegetable (OR = 1.8, p = 0.007) and a lower sweet and salty snack (OR = 1.9, p = 0.001) intake over the course of the first 6 months in university. Higher baseline eating self-regulatory skills were also related to lower weight changes (β = -0.15, p = 0.018) and lower likelihood of gaining 5% initial body weight (OR = 0.52, p = 0.006) at 6-month. Additionally, self-regulatory skills moderated the relationship between baseline BMI and weight changes (β = -0.25, p ≤0.001) and between baseline BMI and 5% weight gain (OR = 0.82, p = 0.008). CONCLUSIONS Starting university with higher eating self-regulatory skills may help students to maintain or achieve a healthy diet and protect them against substantial weight gain, especially among students with overweight.
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Affiliation(s)
- Nathalie Kliemann
- Department of Behavioural Science & Health, University College London, London, UK
| | - Helen Croker
- Department of Behavioural Science & Health, University College London, London, UK
| | - Fiona Johnson
- Department of Behavioural Science & Health, University College London, London, UK
| | - Rebecca J. Beeken
- Department of Behavioural Science & Health, University College London, London, UK,Leeds Institute of Health Sciences, University of Leeds, Leeds, UK,Corresponding author at: Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK.
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Steinglass JE, Glasofer DR, Walsh E, Guzman G, Peterson CB, Walsh BT, Attia E, Wonderlich SA. Targeting habits in anorexia nervosa: a proof-of-concept randomized trial. Psychol Med 2018; 48:2584-2591. [PMID: 29455696 DOI: 10.1017/s003329171800020x] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Habits are behavioral routines that are automatic and frequent, relatively independent of any desired outcome, and have potent antecedent cues. Among individuals with anorexia nervosa (AN), behaviors that promote the starved state appear habitual, and this is the foundation of a recent neurobiological model of AN. In this proof-of-concept study, we tested the habit model of AN by examining the impact of an intervention focused on antecedent cues for eating disorder routines. METHODS The primary intervention target was habit strength; we also measured clinical impact via eating disorder psychopathology and actual eating. Twenty-two hospitalized patients with AN were randomly assigned to 12 sessions of either Supportive Psychotherapy or a behavioral intervention aimed at cues for maladaptive behavioral routines, Regulating Emotions and Changing Habits (REaCH). RESULTS Covarying for baseline, REaCH was associated with a significantly lower Self-Report Habit Index (SRHI) score and significantly lower Eating Disorder Examination-Questionnaire (EDE-Q) global score at the end-of-treatment. The end-of-treatment effect size for SRHI was d = 1.28, for EDE-Q was d = 0.81, and for caloric intake was d = 1.16. CONCLUSIONS REaCH changed habit strength of maladaptive routines more than an active control therapy, and targeting habit strength yielded improvement in clinically meaningful measures. These findings support a habit-based model of AN, and suggest habit strength as a mechanism-based target for intervention.
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Affiliation(s)
- Joanna E Steinglass
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Deborah R Glasofer
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Emily Walsh
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Gabby Guzman
- Rutgers Graduate School of Applied and Professional Psychology
| | | | - B Timothy Walsh
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Evelyn Attia
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Stephen A Wonderlich
- Neuropsychiatric Research Institute/Department of Psychiatry and Behavioral Science University of North Dakota School of Medicine and Health Sciences
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Salvy SJ, Dutton GR, Borgatti A, Kim YI. Habit formation intervention to prevent obesity in low-income preschoolers and their mothers: A randomized controlled trial protocol. Contemp Clin Trials 2018; 70:88-98. [PMID: 29802965 PMCID: PMC6060620 DOI: 10.1016/j.cct.2018.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Low-income and racial/ethnic minority mothers and their young children are at increased risk for obesity. Lack of access to evidence-based obesity prevention and treatment services further contributes to these disparities. METHODS This two-arm, parallel, randomized controlled trial (RCT) tests the effectiveness of a simple obesity intervention (HABITS) delivered as part of ongoing home visitation services, compared to the existing home visitation services without obesity-related content on mothers' and children's obesity risks. HABITS focuses on habit formation and modifications of food and activity cues in the home to support habit formation. Habit formation is focused on improving five behaviors: 1) fruits/vegetables, 2) fried foods, 3) sugar-sweetened beverages, 4) physical activity and 5) self-monitoring. Participants will be 298 mothers (>50% African American; 100% low income) and their children (3-5yo at baseline) enrolled in a home visitation program in central Alabama. Home visitors will be randomly assigned to deliver the home visitation curriculum with or without HABITS as part of their weekly home visits for 9 months. Assessments of mothers (weight, waist circumference, and habit strength of targeted behaviors), children (rate of weight gain), and the food/activity household environment will be conducted at enrollment, post-intervention (9 month), and one year post-intervention follow-up. DISCUSSION This research is poised to have a substantial impact because the delivery modalities of current obesity efforts disproportionally restrict the reach and engagement of underserved, low-income children and their caregivers who are most at-risk for health and obesity disparities.
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Affiliation(s)
- Sarah-Jeanne Salvy
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 616, 1717 11th Avenue South, Birmingham, AL 35205, United States.
| | - Gareth R Dutton
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 615, 1717 11th Avenue South, Birmingham, AL 35205, United States.
| | - Alena Borgatti
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 640, 1717 11th Avenue South, Birmingham, AL 35205, United States.
| | - Young-Il Kim
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 616, 1717 11th Avenue South, Birmingham, AL 35205, United States.
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Abstract
Objective Recent research emphasizes the importance of habit in explaining patterns of energy intake and choices of consumption. However, the nature of the association between habit strength and snacking has not been explored for all types of between-meal snacks. Design Multilevel linear techniques were used to: (i) examine the association between habit strength and moment-to-moment energy intake (kilocalories) from snacks in daily life; and (ii) determine whether gender, age, level of education and BMI moderate the association between habit strength and moment-to-moment energy intake from snacks. A smartphone application based on the experience sampling method was used to map momentary between-meal snack intake in the context of daily life. Demographics and habit strength were assessed with an online composite questionnaire. Setting This research was performed in the Netherlands in the natural environment of participants’ daily life. Subjects Adults (n 269) aged 20–50 years. Results Habit strength was significantly associated with moment-to-moment energy intake from between-meal snacks in daily life: the higher the strength of habit to snack between meals, the higher the amount of momentary energy intake from snacks. The association between habit strength and moment-to-moment energy intake from snacks was moderated by education level. Additional analyses showed that habit strength was significantly associated with moment-to-moment energy intake from between-meal snacks in the low to middle level of education group. Conclusions It is recommended to address habitual between-meal snacking in future interventions targeting low- to middle-educated individuals.
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Hodder RK, O'Brien KM, Stacey FG, Wyse RJ, Clinton‐McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2018; 5:CD008552. [PMID: 29770960 PMCID: PMC6373580 DOI: 10.1002/14651858.cd008552.pub5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2018. We searched Proquest Dissertations and Theses in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 63 trials with 178 trial arms and 11,698 participants. Thirty-nine trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fourteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Nine studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 63 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.There is very low quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 3.50 g as-desired consumption of vegetables (SMD 0.33, 95% CI 0.13 to 0.54; participants = 1741; studies = 13). Multicomponent interventions versus no intervention may have a very small effect on child consumption of fruit and vegetables (SMD 0.35, 95% CI 0.04 to 0.66; participants = 2009; studies = 5; low-quality evidence), equivalent to an increase of 0.37 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; participants = 3078; studies = 11; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for four studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 63 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low- and low-quality evidence respectively that child-feeding practice and multicomponent interventions may lead to very small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up is required and future research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority
Research Centre in Health Behaviour, and Priority Research Centre in
Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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Touyz L, Cohen J, Wakefield C, Grech A, Garnett S, Gohil P, Cohn R. Design and Rationale for a Parent-Led Intervention to Increase Fruit and Vegetable Intake in Young Childhood Cancer Survivors (Reboot): Protocol for a Pilot Study. JMIR Res Protoc 2018; 7:e129. [PMID: 29769170 PMCID: PMC5976864 DOI: 10.2196/resprot.9252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Poor dietary habits are common among childhood cancer survivors, despite increasing their risk of cardio metabolic complications after cancer treatment. Here, we describe the design and rationale for a pilot telephone-based, parent-led intervention aimed at increasing fruit and vegetable intake in young cancer survivors (Reboot). OBJECTIVE This pilot study aims to assess the feasibility and acceptability of delivering evidence-based telephone support to parents of childhood cancer survivors. A secondary aim includes assessing the effect of Reboot on improving childhood cancer survivors' dietary quality by increasing child fruit and vegetable intake and variety and its contribution to overall nutrient intake. METHODS We aim to recruit parents of 15 young cancer survivors aged 2 to 12 years who have completed cancer treatment less than five years ago. The intervention comprises of 4 weekly 45-minute telephone sessions led by a health professional and one booster session 6 weeks later. Sessions address the effects of cancer treatment on children's diets, recommended fruit and vegetable intake for children, and evidence-based strategies to promote the consumption of fruit and vegetables as well as to manage fussy eating. RESULTS Reboot is based on an existing, evidence-based parent nutrition intervention and modified for childhood cancer survivors following extensive collaboration with experts in the field. Primary outcomes of feasibility and acceptability will be measured by the number of participants who complete all five sessions, average session length (minutes), length between sessions (days) and parent Likert ratings of the usefulness and impact of the intervention collected after the booster session. Of the 15 participants we aim to recruit, 3 have completed the intervention, 1 declined to participate, 11 are actively completing the intervention and 2 participants are providing written consent. The remaining 3 participants will be recruited via telephone follow-up calls. The intervention is due to be completed by July 2018. CONCLUSIONS Reboot aims to support healthy dietary behaviors in childhood cancer survivors who are at increased risk of developing serious cardiometabolic complications after their cancer treatment. Results will inform the development and implementation of future evidence-based dietary interventions delivered to childhood cancer survivors, particularly those living in rural and remote areas. REGISTERED REPORT IDENTIFIER RR1-10.2196/9252.
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Affiliation(s)
- Lauren Touyz
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Jennifer Cohen
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Claire Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Allison Grech
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Sarah Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Paayal Gohil
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Richard Cohn
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Chidlren's Health, University of New South Wales Sydney, Sydney, Australia
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Hodder RK, Stacey FG, O'Brien KM, Wyse RJ, Clinton‐McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2018; 1:CD008552. [PMID: 29365346 PMCID: PMC6491117 DOI: 10.1002/14651858.cd008552.pub4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase to identify eligible trials on 25 September 2017. We searched Proquest Dissertations and Theses and two clinical trial registers in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 55 trials with 154 trial arms and 11,108 participants. Thirty-three trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Thirteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 55 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% confidence interval (CI) 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 g of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for three studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 55 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains sparse. There was very low-quality evidence that child-feeding practice interventions are effective in increasing vegetable consumption in children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption in children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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46
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Larsen JK, Hermans RCJ, Sleddens EFC, Vink JM, Kremers SPJ, Ruiter ELM, Fisher JO. How to bridge the intention-behavior gap in food parenting: Automatic constructs and underlying techniques. Appetite 2017; 123:191-200. [PMID: 29277519 DOI: 10.1016/j.appet.2017.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 01/12/2023]
Abstract
Although parents often report positive intentions to promote and create a healthy food environment for their children (e.g., setting limits to snacks offered), they also experience difficulties in translating these intentions into actual behaviors. In this position paper, we argue that automatic processes explain an important part of the gap between parents' intentions and their actual food parenting behaviors. We provide a conceptual framework in which we hypothesize that automatic effects on food parenting occur through two key interrelated constructs: habits (key outcome construct) and volitional regulation behaviors (key mediating construct). Moreover, we discuss potentially important impulse-focused techniques that may directly change habits (e.g., nudging; inhibitory control training) or indirectly through volitional regulation behaviors (e.g., implementation intentions; mental contrasting). We make use of the literature on the role of intention-behavior discordance in general health behaviors and discuss implications for food parenting practices. Our framework provides a dual process view towards food parenting and may help to explain when and why parents are likely to engage in (un)healthy food parenting behaviors. In addition, this framework may hopefully stimulate research on (combinations of old and) new techniques to promote good food parenting behaviors.
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Affiliation(s)
- Junilla K Larsen
- Behavioral Science Institute, Radboud University, PO Box 9104, 6500 HE, Nijmegen, The Netherlands.
| | - Roel C J Hermans
- Behavioral Science Institute, Radboud University, PO Box 9104, 6500 HE, Nijmegen, The Netherlands; Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ester F C Sleddens
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jacqueline M Vink
- Behavioral Science Institute, Radboud University, PO Box 9104, 6500 HE, Nijmegen, The Netherlands
| | - Stef P J Kremers
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Emilie L M Ruiter
- Academic Collaborative Centre AMPHI, Primary and Community Care, ELG 117, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jennifer O Fisher
- Center for Obesity Research and Education, Department of Social and Behavioral Sciences, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia PA 19140, USA
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47
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Dinkel D, Tibbits M, Hanigan E, Nielsen K, Jorgensen L, Grant K. Healthy Families: A Family-Based Community Intervention To Address Childhood Obesity. J Community Health Nurs 2017; 34:190-202. [PMID: 29023158 DOI: 10.1080/07370016.2017.1369808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study was to determine the effectiveness of Healthy Families, a family-based community intervention, in improving the knowledge, self-efficacy, and health behaviors of overweight/obese children and their families as well as to explore the lessons learned. Results showed families who completed the program had significant improvements for children and parents in areas such as nutrition knowledge and self-efficacy in making healthy eating choices as well as participating in physical activity. Additionally, families reported decreasing their intake of sugar-sweetened beverages. Participating families and community partners provided valuable lessons for other communities seeking to implement a similar program.
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Affiliation(s)
- Danae Dinkel
- a School of Health and Kinesiology , University of Nebraska at Omaha , Omaha , Nebraska
| | - Melissa Tibbits
- b Department of Health Promotion, Social & Behavioral Health , University of Nebraska Medical Center College of Public Health , Omaha , Nebraska
| | - Emily Hanigan
- c UNMC School of Allied Health, Physician Assistant Studies , University of Nebraska Medical Center , Omaha , Nebraska
| | - Kelly Nielsen
- d Healthier Communities and Community Benefit , CHI Health (Catholic Health Initiatives) , Omaha , Nebraska
| | - Leah Jorgensen
- e OneWorld Community Health Center , Omaha , Nebraska.,f Office of Health Professions Education , Nebraska Medicine , Omaha , Nebraska
| | - Kay Grant
- e OneWorld Community Health Center , Omaha , Nebraska.,f Office of Health Professions Education , Nebraska Medicine , Omaha , Nebraska
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48
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Hodder RK, Stacey FG, Wyse RJ, O'Brien KM, Clinton‐McHarg T, Tzelepis F, Nathan NK, James EL, Bartlem KM, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2017; 9:CD008552. [PMID: 28945919 PMCID: PMC6483688 DOI: 10.1002/14651858.cd008552.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase Classic and Embase to identify eligible trials on 30 September 2016. We searched CINAHL and PsycINFO in July 2016, Proquest Dissertations and Theses in November 2016 and three clinical trial registers in November 2016 and June 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures.We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 50 trials with 137 trial arms and 10,267 participants. Thirty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Eleven trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.Thirteen of the 50 included trials were judged as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias of remaining studies.Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% CI 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 grams of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions.Studies reported receiving governmental or charitable funds, except for two studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 50 eligible trials of various intervention approaches, the evidence for how to increase fruit and vegetable consumption of children remains sparse. There was very low-quality evidence child-feeding practice interventions are effective in increasing vegetable consumption of children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption of children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | | | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter Population HealthLocked Bag 10WallsendAustralia
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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Fritz H, Brody A, Levy P. Assessing the feasibility, acceptability, and potential effectiveness of a behavioral-automaticity focused lifestyle intervention for African Americans with metabolic syndrome: The Pick two to Stick to protocol. Contemp Clin Trials Commun 2017; 7:166-171. [PMID: 29696181 PMCID: PMC5898536 DOI: 10.1016/j.conctc.2017.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/09/2017] [Accepted: 06/21/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) significantly increases the risk of developing diabetes and cardiovascular disease. Being physically active and eating a healthy diet can reduce MetS risk factors. Too frequently, however, studies report that the effects of interventions targeting those factors are not maintained once interventions are withdrawn. A potential solution to the problem is targeting behavioral automaticity (habit-development) to aid in initiation and maintenance of health-behavior changes. The Pick two to Stick To (P2S2), is an 8-week, theory-based hybrid (face-to-face/telecoaching) habit focused lifestyle intervention designed to increase healthful physical activity and dietary behavioral automaticity. The purpose of this article is to describe the rationale and protocol for evaluating the P2S2 program's feasibility, acceptability and potential effectiveness. METHODS Using a prospective, non-comparative design, the P2S2 program will be implemented by trained occupational therapy 'coaches' to 40 African Americans aged 40 and above with MetS recruited from the emergency department. Semi-structured interviews with participants, bi-weekly research meetings with study staff, and observations of intervention delivery will provide data for a process evaluation. Estimates of effectiveness include weight, blood pressure, waist circumference, BMI, and behavioral automaticity measures that will be collected at baseline and week 20. CONCLUSION The P2S2 program could facilitate the development of healthful dietary and physical activity habits in an underserved population. Whether interventions aimed at changing habits can feasibly influence this automaticity, particularly for high-risk, low resource communities where other barriers exist, is not known. This pilot study, therefore, will fill an important gap, providing insight to inform subsequent trials.
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Affiliation(s)
- Heather Fritz
- Eugene Applebaum College of Pharmacy and Health Sciences, Occupational Therapy Program, Wayne State University, Detroit, MI 48201, United States
- Institute of Gerontology, Wayne State University, Detroit, MI 48202, United States
| | - Aaron Brody
- Department of Emergency Medicine, Wayne State University, Detroit, MI 48201, United States
| | - Philip Levy
- Department of Emergency Medicine and Assistant Vice President for Translational Science and Clinical Research Innovation, Wayne State University, Detroit, MI 48201, United States
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Croker H, Beeken RJ. Applied Interventions in the Prevention and Treatment of Obesity Through the Research of Professor Jane Wardle. Curr Obes Rep 2017; 6:57-62. [PMID: 28265868 PMCID: PMC5359372 DOI: 10.1007/s13679-017-0249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE OF REVIEW Obesity presents a challenge for practitioners, policy makers, researchers and for those with obesity themselves. This review focuses on psychological approaches to its management and prevention in children and adults. RECENT FINDINGS Through exploring the work of the late Professor Jane Wardle, we look at the earliest behavioural treatment approaches and how psychological theory has been used to develop more contemporary approaches, for example incorporating genetic feedback and habit formation theory into interventions. We also explore how Jane has challenged thinking about the causal pathways of obesity in relation to eating behaviour. Beyond academic work, Jane was an advocate of developing interventions which had real-world applications. Therefore, we discuss how she not only developed new interventions but also made these widely available and the charity that she established.
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Affiliation(s)
- Helen Croker
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Rebecca J. Beeken
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
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