Effect of a Plant-based Intervention Among Black Individuals in the Deep South: A Pilot Study

ObjectiveTo explore the feasibility, acceptability, and clinical/behavioral outcomes of a remotely-delivered, culturally-tailored plant-based nutrition and lifestyle intervention designed to improve cardiovascular risk among Black adults in a rural, Black Belt community.MethodsWe implemented a 12-week intervention with weekly educational sessions, cooking lessons, social support, exercise, and food items.Outcome(s)Body mass index, waist circumference, total cholesterol, low-density lipoprotein, high-density lipoprotein, high-sensitivity C-reactive protein, trimethylamine N-oxide, diet/physical activity. Paired t tests analyzed preintervention and postintervention differences (n = 24).ResultsBody mass index and waist circumference were reduced (P < 0.001), and total and low-density lipoprotein cholesterol decreased by 10.8% and 13.9%, respectively (P < 0.05). There was a 25.8% reduction in high-sensitivity C-reactive protein (P = 0.02). Diet and physical activity were also improved.Conclusions and ImplicationsThis pilot study demonstrated the feasibility and acceptability of a remotely-delivered intervention focused on improving cardiovascular risk through plant-based nutrition, physical activity/wellness, social support, and cultural adaptability. Larger scale and longer-term studies are needed.     

Nutrition Knowledge and Associated Behavior Changes in a Holistic,Short-term Nutrition Education Intervention with Low-income Women

ObjectiveTo assess the impact of a short-term nutrition intervention using education on a comprehensive array of nutrition and health topics in low-income women.DesignPre- and postintervention surveys; 1 study condition (intervention group); experiential learning; pilot testing of education sessions.SettingCommunity centers, homeless shelters, or University of Minnesota, in Minneapolis–St Paul metropolitan area.ParticipantsEthnically diverse, low-income women (n = 118), 23–45 years of age.InterventionThree educational sessions providing a comprehensive curriculum of nutrition and health education via experiential and interactive lectures, activities, and demonstrations. One week to implement knowledge and behavioral changes, and pre- and postsurvey sessions to collect anthropometric data and evaluate changes in knowledge and behavior.Main Outcome MeasuresHealth benefits of all food groups; identification of healthful foods; shopping, cooking, and gardening; and energy balance.AnalysisPaired t tests, Pearson correlations.ResultsPostintervention increases in nutrition knowledge and favorable nutrition behavioral changes (P < .05).Conclusions and ImplicationsA short-term nutrition intervention using comprehensive nutrition and health education through experiential and interactive lessons, activities, and demonstrations has the capacity to increase nutrition knowledge and favorably change nutrition behaviors in a sample of low-income women.     

Nutrition Environment at Food Pantries Improves After Fresh Produce Donation Program

ObjectiveTo evaluate the influence of the Growing Together Illinois fresh produce donation program and understand factors that affect produce distribution at participating food pantries.MethodsIn this intervention at 17 Illinois food pantries, Master Gardeners supported food donation gardens, and Supplemental Nutrition Assistance Program Education provided educational and environmental interventions to increase selection and use of fresh produce. This mixed-methods pre-post study assessed pantry characteristics and program impact via Nutrition Environment Food Pantry Assessment Tool evaluations, interview feedback from pantry staff, and structured pantry observations.ResultsPantries experienced significant increases from preintervention to postintervention in providing various types of produce, marketing and nudging healthful products, providing additional resources, and total Nutrition Environment Food Pantry Assessment Tool scores. Participants had positive feedback about the program and educational interventions and reported the weekly timing of donations mitigated potential storage and spoilage issues.Conclusions and ImplicationsFuture research could focus on approaches to increase fresh produce in food pantries while supporting clients via nutrition and cooking education.     

An innovative medical school curriculum to address human papillomavirus vaccine hesitancy

BackgroundVaccination rates against Human Papillomavirus (HPV) in the US remain alarmingly low. Physicians can significantly influence a parent’s decision to vaccinate their children. However, medical education often lacks training on specific strategies for communicating with vaccine hesitant parents.MethodsWe created an innovative curriculum designed to teach medical students how to address HPV vaccine hesitancy. The curriculum consisted of (1) a presentation on the epidemiology, biology, and disease morbidity associated with HPV, (2) a video that teaches specific communication strategies and (3) role-playing simulations. This curriculum was delivered to medical students at two separate sites. Medical students were surveyed before and after completing the educational curriculum. The surveys assessed student comfort talking to HPV vaccine hesitant parents and their likelihood to recommend the HPV vaccine.ResultsPre- and post-intervention surveys were completed by 101 of the 132 participants (77% response rate). After the intervention, student awareness of the benefits of the HPV vaccine increased by a mean of 0.82 points (Likert scale 1–5, p < 0.01) and student comfort talking to vaccine hesitant parents increased by a mean of 1.37 points (p < 0.01). Prior to the intervention, students more strongly recommended the HPV vaccine to females compared to males, but this gender disparity was eliminated after the intervention (p < 0.01). Personal vaccination status was independately associated with a higher likelihood of recommending the HPV vaccine both before and after the intervention.ConclusionOur innovative curriculum improved medical student comfort level discussing HPV vaccination with hesitant parents and increased the perceived likelihood of recommending HPV vaccination. The intervention is easy to implement, scalable, and requires minimal resources. Educating future providers on this important topic has the potential to improve vaccination rates nationwide and thus should be considered for all medical students.     

Using Educational Videos and Perspective-Taking to Communicate Gene-By-Environment Interaction Concepts about Eating Behavior: Effects on Empathy and Weight Stigma

ObjectiveThis study investigated whether education about gene-by-environment interaction (G × E) concepts could improve G × E knowledge and positively affect empathy and weight stigma.DesignWe conducted a randomized trial using a 2 × 2 between-subjects design.SettingOnline.ParticipantsFive hundred eighty-two American participants from the Prolific platform.InterventionParticipants were randomly assigned to watch an educational or a control video. Participants then watched a set of vignette scenarios that depicted what it is like to have a predisposition toward obesogenic eating behaviors from either a first-person or third-person perspective.Main Outcome Measure(s)Participants completed questionnaires measuring G × E knowledge, causal attributions, weight stigma, and empathy postintervention.AnalysisTwo-by-two between-subjects ANOVAs and exploratory mediation analyses were conducted.ResultsParticipants who watched the educational video demonstrated greater G × E knowledge, reported higher empathy toward the characters in the vignette scenarios and held fewer stigmatizing attitudes (notably blame) toward individuals with higher weight. Exploratory mediation analyses indicated that the educational video led to these positive downstream effects by increasing the extent to which participants attributed genetic causes to eating behaviors.Conclusions and ImplicationsEducation about G × E causes of eating behaviors can have beneficial downstream effects on attitudes toward people with higher weight.     

Pilot Study of a Virtual Nutrition Intervention for Adolescents and Young Adults With Autism Spectrum Disorder

ObjectiveExamine the impact of a virtual nutrition education program, Bringing Adolescent Learners with Autism Nutrition and Culinary Education (BALANCE), on dietary intake and psychosocial determinants of healthy eating in adolescents and young adults (AYA) with autism spectrum disorder (ASD).MethodsA sample of AYA with ASD aged 12–21 years (n = 27; 6 groups of 2–7 adolescents) participated in BALANCE, a Social Cognitive Theory-based intervention, for eight 30–45-minute lessons. Outcomes were compared using a pre-post design and included dietary intake (assessed using a food frequency questionnaire) and psychosocial determinants of healthy eating (assessed by a validated survey). Wilcoxon signed-rank tests compared preintervention and postintervention medians with an alpha level of 0.05.ResultsMean added sugar intake (P = 0.026) decreased, and behavioral strategies (P = 0.010), self-efficacy (P < 0.001), and outcome expectations (P = 0.009) improved. There was no difference in fruit or vegetable intake or other psychosocial determinants.Conclusions and ImplicationsThe BALANCE intervention may improve psychosocial determinants and dietary behaviors in AYA with ASD. Future virtual programs may incorporate more assistance and support to be accessible for AYA with ASD of varying severity levels.     

Marketing Sustainability Analysis of Stores Participating in a Healthier Retail Food Program

ObjectivesTo examine how food retailers completing Shop Healthy NYC, a healthy food retail program, (1) changed availability, placement, and promotion of healthier food immediately after participation and (2) sustained changes 1-year postintervention.MethodsFrom 2014 to 2017, stores in 2 high-poverty New York City neighborhoods participated in a low-intensity intervention focused on in-store advertising or a high-intensity intervention to meet 7 criteria related to availability, placement, and promotion of healthy items. Stores were assessed preintervention (Pre), 1-month postintervention (Post 1), and 12–16 months postintervention (Post 2). Analyses were restricted to stores that completed the intervention and were assessed at all time points (n = 64). Changes were compared across time points.ResultsAcross stores participating in the low-intensity intervention, the ratio of unhealthy-to-healthy ads decreased from Pre to Post 1, and by Post 2 remained improved over baseline. Among stores participating in the high-intensity intervention, the median number of healthy criteria met increased from 3.5 to 6 from Pre to Post 1 and decreased to 5 at Post 2.ConclusionsImprovements in the marketing and availability, placement, and promotion of healthy products are feasible but may require reinforcement and additional support over time.     

Evaluation of an intervention designed to improve the management of difficult IUD insertions by advanced practice clinicians

ObjectivesTo assess whether clinical skills training in cervical dilation and paracervical anesthesia, as well as the introduction of a clinical protocol for difficult insertions, increased intrauterine device (IUD) insertion success rates among advanced practice clinicians (APCs) including women's health and family practice nurse practitioners, physician assistants and certified nurse midwives.Study designThis prospective study assessed an intervention to improve IUD insertions among APCs at six family planning clinics in Utah. We collected data on IUD insertions performed by participating clinicians during two observation phases: preintervention (Phase 1) and postintervention (Phase 2). Using electronic medical records, we tracked patient characteristics, IUD insertion success, difficulties and failures. We constructed a mixed-effects logistic regression model to control for provider and patient demographics influencing insertion success rates.ResultsNine clinicians participated in both preintervention and postintervention phases. The analysis included 428 IUD insertion procedures (242 preintervention and 186 postintervention). During Phase 1, 31/242 (12.8%) insertions failed. Insertion rates in Phase 2 improved with only 8/186 (4.3%) failures. Using mixed-effects logistic regression, the odds of a successful insertion postintervention was 4.8 times greater than preintervention (aOR = 4.8.95% CI 1.8–12.7) when controlling for provider and patient characteristics. Increased risk of insertion failure was associated with nulliparity and younger age during Phase 1, but not during Phase 2.ConclusionsA brief training for APCs and the use of a clinical protocol for difficult insertions may be able to improve IUD insertion rates.ImplicationsClinics with high rates of IUD insertion failure can improve care with a simple intervention, which may yield significant benefits in IUD service delivery.     

An introductory educational session improves medical student knowledge and comfort levels in caring for patients with physical disabilities

BackgroundDespite a growing number of people living with disabilities (PWD), many experience health disparities related to access to high quality medical care. Lack of knowledge and low comfort level of medical providers in caring for PWD is a significant barrier and can lead to poor health outcomes. Education of future physicians is an important factor in addressing these health disparities.Objective/HypothesisThe objective of this study is to assess the knowledge and comfort level of first-year medical students towards PWD before and after a mandatory educational session focused on the health disparities and appropriate care of PWD. We hypothesized that this introductory session would lead to a greater awareness and improved comfort level around caring for PWD.MethodsFor the two academic years 2016–2018, we created a mandatory educational session for first-year students consisting of a 30-min lecture followed by discussion of video vignettes and a PWD patient panel. Students completed pre- and post-session surveys that evaluated changes in knowledge and comfort levels around working with PWD, and elicited their feedback.Results355 students participated in the educational session and among 278 matched pre- and post-survey responses, we found a significant improvement in knowledge and comfort levels towards encountering PWD. Student feedback was overwhelmingly positive with the PWD panel receiving the highest effectiveness rating.ConclusionA mandatory educational session for medical students including didactics, videos, and testimonials on caring for PWD improved students’ knowledge and comfort levels. Additional research on the long-term effects of early training is needed.     

Serving Breakfast Free to All Students and Type of Breakfast Serving Model Are Associated with Participation in the School Breakfast Program

BackgroundMany students experience challenges participating in the School Breakfast Program (SBP) when breakfast is served before school in the cafeteria. Serving breakfast free to all students or offering innovative breakfast serving models, such as breakfast in the classroom (BIC), grab n’ go, or second chance breakfast, may encourage higher SBP participation rates.ObjectiveTo examine the association between offering breakfast free to all students as well as breakfast serving model with student participation in the SBP in October 2017 among public schools in North Carolina.DesignCross-sectional study using data from the North Carolina Department of Public Instruction.Participants/settingThis study included data from 2,285 North Carolina public schools who served breakfast in October 2017 with 1,445,287 students.Main outcome measuresThe main outcome measures are the odds of a student participating in the SBP among students overall, students eligible for free or reduced-price (FRP) meals, and students not eligible for FRP meals.Statistical analyses performedMultiple logistic regression assessed the association between offering breakfast free to all students and breakfast serving model with the probability of participating in the SBP (number of students participating out of number of students enrolled) for students overall, eligible for FRP meals, and not eligible for FRP meals. Statistical models were stratified by school type (elementary, middle, and high schools).ResultsBreakfast serving models positively associated with SBP participation were BIC and BIC plus grab n’ go for elementary and high school students and grab n’ go and second chance for middle and high school students (P<0.05). Serving breakfast free to all students was positively associated with SBP participation alone and in combination with BIC, second chance, and BIC plus grab n’ go (P<0.05).ConclusionsServing breakfast free to all students and breakfast serving model were associated with SBP participation, and different relationships existed for different school levels.     

The Effects of Young Adults Eating and Active for Health (YEAH): A Theory-Based Web-Delivered Intervention

ObjectiveTo assess the effectiveness of a tailored theory-based, Web-delivered intervention (Young Adults Eating and Active for Health) developed using community-based participatory research process.DesignA 15-month (10-week intensive intervention with a 12-month follow-up) randomized, controlled trial delivered via Internet and e-mail.SettingThirteen college campuses.ParticipantsA total of 1,639 college students.InterventionTwenty-one mini-educational lessons and e-mail messages (called nudges) developed with the non-diet approach and focusing on eating behavior, physical activity, stress management, and healthy weight management. Nudges were short, frequent, entertaining, and stage-tailored to each behavior, and reinforced lesson content.Main Outcome MeasureAll participants were assessed at baseline, postintervention (3 months from baseline), and follow-up (15 months from baseline) for primary outcomes of weight, body mass index (BMI), fruit and vegetable intake (FVI), physical activity (PA), and perceived stress; and secondary outcomes of waist circumference, percent dietary fat, energy from sugar-sweetened beverages, servings of whole grains, self-instruction and regulation for mealtime behavior, hours of sleep, and stage of readiness for change for consuming 5 cups of FVI, completing 150 minutes of PA/wk, and managing stress on most days of the week. Demographics were collected at baseline.AnalysisChi-square analysis and mixed-models repeated measures analysis were performed to determine differences between experimental and control outcomes.ResultsThere were no differences between experimental and control participants in BMI, weight, and waist circumference. There were small improvements in FVI (P = .001), vigorous PA in females (P = .05), fat intake (P = .002), self-instruction (P = .001), and regulation (P = .004) for mealtime behavior, and hours of sleep (P = .05) at postintervention, but improvements were not maintained at follow-up. At postintervention, a greater proportion of experimental participants were in the action/maintenance stages for FVI (P = .019) and PA (P = .002) than control.Conclusions and ImplicationsYoung Adults Eating and Active for Health is one of the first studies to use the community-based participatory research process of PRECEDE-PROCEED to develop a non-diet approach intervention. Although there were no differences between experimental and control participants in weight change or BMI, the intervention supported positive change in behaviors that may mediate excessive weight gain, such as increasing FVI and more healthful self-regulation mealtime behaviors immediately postintervention. Additional strategies to maintain the behavior changes need to be explored.     

Electronic Health Record Reminders for Chlamydia Screening in an American Indian Population

ObjectivesIndian Health Service (IHS) screening rates for Chlamydia trachomatis are lower than national rates of chlamydia screening in the Southwest. We describe and evaluate the effect of a public health intervention consisting of electronic health record (EHR) reminders to alert health care providers to screen for chlamydia at an IHS facility. We also conducted an awareness presentation among health care providers on chlamydia screening.MethodsWe conducted our intervention from November 1, 2013, through October 31, 2015, at an IHS facility in the Southwest. We implemented algorithms that queried database values to assess chlamydia screening performance in 6 clinical departments. We presented data on the screening performance of clinical departments and health care providers (de-identified) in the awareness presentations. We re-queried database values 1 and 2 years after implementation of the EHR reminder intervention to evaluate before-and-after screening rates, comparing data among all patients and among female patients only.ResultsWe found small, sustained relative increases in chlamydia screening rates during the 2012-2015 evaluation period: 20.8% pre-intervention to 24.9% and 24.2% one and two years postintervention, respectively, across all patients; 32.3% preintervention to 36.6% and 35.6% one and two years postintervention, respectively, among female patients. Increases in clinical department–specific screening rates varied and were most prominent in internal medicine (35.8% preintervention to peak 65.8% postintervention). The 1 clinic (obstetrics–gynecology) that did not receive an awareness presentation showed a consistent downward trend in screening rates, although absolute rates were consistently higher in that clinic than in other clinics.ConclusionsAwareness presentations that offer feedback to health care providers on screening performance, heighten provider awareness of the importance of chlamydia screening, and promote development of novel provider-initiated screening protocols may help to increase screening rates when combined with EHR reminders.     

Reducing Occupational Risk for Blood and Body Fluid Exposure Among Home Care Aides: An Intervention Effectiveness Study

The purpose of this quasi-experimental pretest/posttest research study was to examine the effectiveness of an intervention designed through a participatory process to reduce blood and body fluid exposure among home care aides. Employer A, the intervention site, was a large agency with approximately 1,200 unionized home care aides. Employer B, the comparison group, was a medium-sized agency with approximately 200 home care aides. The intervention was developed in partnership with labor and management and included a 1-day educational session utilizing peer educators and active learning methods to increase awareness about the risks for occupational exposure to blood and body fluids among home care aides and a follow-up session introducing materials to facilitate communication with clients about safe sharps disposal. Self-administered preintervention and postintervention questionnaires identifying knowledge about and self-reported practices to reduce bloodborne pathogen exposure were completed in person during mandatory training sessions 18 months apart. Home care aides in the intervention group for whom the preintervention and postintervention questionnaires could be directly matched reported an increase in their clients’ use of proper sharps containers (31.9% pre to 52.2% post; p = .033). At follow-up, the intervention group as a whole also reported increased use of sharps containers among their clients when compared to controls (p = .041).     

Association Between Educational Attainment and EFNEP Participants’ Food Practice Outcomes

ObjectiveExamine the association between educational attainment and improvement in food practice outcomes of the California Expanded Food and Nutrition Education Program (EFNEP) participants.DesignSecondary data analysis.ParticipantsA total of 19,089 participants, 92.3% female, 77.2% Hispanic, 19.7% with ≤ sixth-grade education, and 68.9% with incomes ≤ 100% of the federal poverty level.Main Outcome MeasuresImprovement in food resource management practices (FRMP), nutrition practices, and food safety practices (FSP).AnalysisWilcoxon signed rank tests examined pre-post outcomes. Mann-Whitney U tests compared whether participants in the lowest and highest educational attainment quartiles had similar levels of improvement.ResultsCalifornia EFNEP is associated with improved FRMP (z = ?95.33), nutrition practices (z = ?94.91), and FSP (z = ?92.37); (P < 0.001). Lowest educational quartile was associated with more improvement in FRMP and FSP (P < 0.001).Conclusions and ImplicationsCalifornia EFNEP contributed to improved food practice outcomes for low and high educational attainment participants. Program content and instruction are effective across the education continuum.     

Comprehensive Behavioral-Motivational Nutrition Education Improves Depressive Symptoms Following Bariatric Surgery: A Randomized,Controlled Trial of Obese Hispanic Americans

ObjectiveTo evaluate the effect of 2 post-bariatric support interventions on depressive symptoms of Hispanic Americans treated with gastric bypass for morbid or severe obesity.Design/SettingProspective randomized, controlled trial conducted in a laparoscopic institution.Participants/InterventionsDuring the Phase 1 clinical trial (from preoperative evaluation to 6 months after surgery), all participants received standard care. During Phase 2 (6–12 months after surgery), participants were randomly assigned to receive either standard care (n = 72) or comprehensive support (n = 72). Comprehensive group participants received 6 educational sessions focused on behavior change strategies and motivation with nutrition counseling.Main Outcome MeasuresDepression scores and weight change over time.AnalysisIndependent samples t tests and regression analysis assessed relationships among depression scores and excess weight loss.ResultsParticipants receiving behavioral-motivational intervention scored significantly lower on Beck's Depression Inventory questionnaire scores than those receiving standard care. For those with depressive symptoms at randomization, 24% of participants who received the comprehensive intervention reported no depressive symptoms at 12 months after surgery, compared with 6% of those who received standard care (P < .001). Patients' depressive mood improvement was significantly and positively associated with excess weight loss and attendance at educational sessions (P < .001).Conclusions and ImplicationsFindings support the importance of post-bariatric comprehensive behavioral-motivational nutrition education for decreasing risk for depression and improving weight loss.     

Older Women in a State-Wide,Evidence-Based Falls Prevention Program: Who Enrolls and What Benefits Are Obtained?

BackgroundOlder women who are vulnerable to falls and their negative consequences have been shown, in controlled randomized clinical trials, to benefit from fall prevention programs. The purpose of this study was to identify personal characteristics of female participants enrolled in a falls prevention program, the effectiveness of the program for female participants, and whether personal characteristics indicate which women might benefit most from programs delivered in real-world settings.MethodsData were collected from seniors enrolled in A Matter of Balance/Voluntary Lay Leader (AMOB/VLL) program sessions conducted in Texas over the 2-year period from 2007 to 2009. Baseline and postintervention data from 1,101 female participants were drawn from a larger, state-wide dataset and analyzed using structural equation modeling to identify relationships between variables of interest.FindingsAnalyses revealed that women who attended AMOB/VLL significantly increased falls efficacy from baseline to postintervention (t = 1.680; p < .05; d = 0.143) and reduced the number of times fallen (t = 3.790; p < .01; d = 0.313). Further, participants reported decreases in days of physical (t = 3.810; p < .01; d = 0.323) and mental health (t = 1.850; p < .05; d = 0.156) reported as not good.ConclusionFindings from this study support the effectiveness of evidence-based programs for reducing falls-related risks in older women. Identifying the characteristics of female participants enrolled in AMOB/VLL can enable public health professionals to better target and meet the health demands of the aging female population. Such translational research can help to guide the dissemination of additional state-wide health promotion programs for older women.     

The Efficacy of a Brief,Altruism-Eliciting Video Intervention in Enhancing COVID-19 Vaccination Intentions Among a Population-Based Sample of Younger Adults: Randomized Controlled Trial

BackgroundHigh COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance.ObjectiveThis study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video’s efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures.MethodsUsing a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention.ResultsAnalyses were performed on 1373 participants (n=686, 50%, in the video arm, n=687, 50%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine (χ²₁=20.55, P<.001). The between-group difference in postintervention intentions (χ²₃=1.70, P=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate.ConclusionsAlthough the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a “push” for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases.Trial RegistrationClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT04960228","term_id":"NCT04960228"}}NCT04960228; https://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT04960228","term_id":"NCT04960228"}}NCT04960228     

"Eat healthy, stay active!": a coordinated intervention to improve nutrition and physical activity among head start parents, staff, and children

Abstract Purpose . Examine the effectiveness of the "Eat Healthy, Stay Active!" pilot program, a multisite, 6-month educational intervention to promote healthy nutrition and physical activity among Head Start staff, parents, and children. Design . Comparison of within-group preintervention and postintervention knowledge and behavior, along with anthropomorphic measurements. Setting . The study was conducted in a convenience sample of six large Head Start agencies in five states. Subjects . Participants included 496 staff, 438 parents, and 112 preschool children. Intervention . The 6-month intervention consisted of core trainings and reinforcing activities for staff and parents that aligned with children's curricula. Measures . Pre-post questionnaires and anthropometric measurements examined changes in body mass index (BMI), knowledge, and behaviors related to nutrition and physical activity. Analysis . Paired t-tests to compare preintervention and postintervention weights and BMI; multiple regression analyses to examine associations between weight changes and other covariates, including knowledge and behavior changes, controlling for sociodemographic variables. Results . Each group of participants demonstrated significant reductions in BMI (mean = 30.1 to 29.2; p < .001 in adults and 17.0 to 16.6; p < 0.001 in children) and in the proportion of obese children (30% to 21%; p < .001) and adults (45% to 40%; p < .001). Child weight changes correlated with parent weight changes. Conclusion . This intervention showed promising initial results, with potential effectiveness as an intervention to promote healthier behaviors among adults and children in Head Start settings.