Efficacy of a minimal intervention to reduce fat intake

Effective dietary interventions must be developed to reduce fat intake in whole populations, rather than clinical subgroups. This study tested the effects of personalised feedback on fat intake in a general population. Hospital workers (n = 801) were randomised to receive personalised feedback or no personalised feedback. Personalised feedback consisted of one sentence expressing current fat intake as a percentage of total calorific intake. Changes in fat intake from baseline to five months post-intervention were evaluated. The personalised intervention produced significant decreases in total and saturated fat intake, compared with the control group. Total-fat decreased by 8.6% (versus 0.2% in the control group); saturated fat decreased by 9.3% (versus 1.7% in the control group). Fat intake as a proportion of total calorific intake did not decrease significantly in either condition. Findings also revealed differential effects of feedback on high- versus low-fat consumer groups. Personalised feedback significantly reduced fat intake in high-fat consumers, and prevented low-fat consumers from increasing their fat intake. Personalised fat feedback therefore represents an efficacious and low-intensity approach to the reduction of fat intake in the general population.     

Tailoring dietary feedback to reduce fat intake: an intervention at the family level

In this study, we wished to investigate whether the use of tailored nutrition education letters addressed to each family member simultaneously at home could serve as a valuable strategy for nutrition education. Family quartets (both parents and two adolescents, all healthy individuals) were chosen to be the units of intervention. The first aim of our study was to investigate the impact of tailored versus standardized nutrition education on fat intake and on psychosocial determinants of fat intake in families, using a randomized dietary feedback study. Our second aim was to study the differential effect of the tailored nutrition education on different family members. Analyses were conducted among 18 experimental families (n = 72) and 17 control families (n = 68). The tailored intervention was more effective than the nontailored intervention in reducing total and saturated fat intake when all the family members were included (F = 4.0, P < 0.05 and F = 5.9, P < 0.05). However, follow-up analyses revealed that only mothers benefit from the tailored intervention (F = 6.4, P < 0.05 and F = 10.2, P < 0.005). For fathers and adolescents, both interventions resulted in a significant decrease in fat scores. Furthermore, tailored feedback resulted in stronger awareness of personal fat intake and awareness of fat intake of family members. Tailored advice has the potential to communicate the personal need to change. As differences in fat reduction between family members receiving general or tailored nutrition education letters were smaller than expected, future research will have to prove that family-based tailored interventions are more effective than standardized interventions and interventions focusing on a single person. It also needs to be clarified why mothers in particular benefit from tailored feedback.     

Diet intervention methods to reduce fat intake: nutrient and food group composition of self-selected low-fat diets

A multicentered pilot study was conducted to test an intervention protocol designed to reduce fat intake to 15% of energy intake. Eligible subjects were postmenopausal women with stage II breast cancer whose baseline fat intake was more than 30% of energy intake. The low-fat diet intervention protocol consisted of bi-weekly individual counseling sessions with emphasis on substitution of lower-fat foods for high-fat foods and maintenance of nutritional adequacy. Nutrient intakes were calculated from 4-day food records collected at baseline and after 3 months of diet intervention. Mean daily fat intake for the 17 patients on the low-fat diet dropped significantly from 38.4 +/- 4.3% of energy intake at baseline to 22.8 +/- 7.8% at 3 months (p less than .001). A 25% reduction in mean energy intake, from 1,840 +/- 419 kcal at baseline to 1,365 +/- 291 kcal at 3 months, was accompanied by significant increases in protein and carbohydrate as percent of energy intake. A mean weight loss of 2.8 kg and a 7.7% reduction in serum cholesterol were observed; both changes were significant at the p less than .01 level. Absolute intakes of zinc and magnesium were significantly reduced. However, mean intake on the low-fat diet for 14 vitamins and minerals, including zinc and magnesium, exceeded two-thirds of the 1989 Recommended Dietary Allowances (RDAs). When expressed as nutrient density (i.e., amount of nutrient per 1,000 kcal), increases were observed for all micronutrients. These results support the hypothesis that a nutritionally adequate low-fat diet can be successfully implemented in a highly motivated, free-living population.     

Acceptability and feasibility of an interactive computer-tailored fat intake intervention in Belgium

In order to reduce the risk of chronic diseases health authorities recommend restricting fat intake to 30% of the total energy uptake. However, fat intake in Belgium is much higher warranting interventions aimed at reducing fat intake. Tailored interventions have shown to be promising; however, studies on effectiveness of interactive computer-tailored systems are needed. We investigated the acceptability and feasibility of a recently developed interactive computer-tailored fat reduction intervention. Differences in the reported acceptability and feasibility according to demographic and stages of change were explored. Participants (n = 220) completed a computerized questionnaire, and received a personal fat intake advice, which was almost immediately displayed on screen. They also completed an evaluation questionnaire, during and after they ran the tailored program, with questions on the quality, user-friendliness and applicability of the program. Participants rated the program positively on all aspects. No significant differences in acceptability and feasibility scores were found according to sex, education levels and computer literacy. Although several significant differences were found between age groups and stages of change (oldest group, contemplators and preparators were more positive about the program), the importance of these differences is probably not great, since acceptability and feasibility scores for the different age groups and stages of change were always very high. These results suggest that the computer-tailored intervention is an acceptable and feasible tool for reducing fat intake in a general population in Belgium.     

Influences on intention to reduce dietary intake of fat and sugar

A theoretical understanding of factors influencing nutrition behavior can potentially enhance the effectiveness of educational strategy design. This cross-sectional study used the Ajzen and Fishbein theory of reasoned action to examine specific factors influencing intentions to reduce dietary intake of fat and sugar (“dieting”). A questionnaire was developed to measure belief, value and social influences on intention to reduce fat and sugar intake; the behavioral intention (BI) to reduce fat and sugar intake; and current self-reported fat and sugar restriction. The subjects were university health and non-health majors. Regression analysis revealed that both subjective norms and attitudes toward the behavior predicted the subject's intention to reduce fat and sugar intake. For health majors, the attitude toward the behavior was more influential in predicting BI; for the non-health majors, the subjective norm was more important. Those reporting current restriction of fat and sugar intake also had significantly more positive behavioral beliefs about health benefits than those not reporting restriction. Implications for the development of educational programs include the importance of identifying primary motivational factors (attitudes or social influences), and specific belief and value perceptions for intervention in targeted populations.     

Patient attitudes towards and experiences with an intervention programme to reduce chronic acid-suppressing drug intake in primary care

Abstract

Objective: Many patients are using acid-suppressing drugs (ASD) unnecessary. An insurance company initiated intervention programme aiming at reduction of chronic ASD use, was introduced in primary care-practices. We evaluated the attitude and experiences of the participating patients. Methods: A survey was conducted among a random sample of 2376 long-term ASD users using a validated questionnaire that combined CAHPS and QUOTE methodology. Using a psychometric principal component analysis we assessed the role of GPs in three scales: quality of support; communication and conduct; involvement in decisions. Both the importance of and experiences with quality items, transformed into quality impact indices, were measured. Results: Of 2376 questionnaires distributed, 1808 (76%) were returned, 1270 (54%) were valid. 188 were of patients that participated in the programme. The majority was dissatisfied with the GPs’ support: no information about rebound side effects (76%), lifestyle habits (68%), and reasons to stop (50%). Compared to the non-participants 9% more participants stopped ASD use (P = 0.04).

Conclusion: A majority of patients on chronic ASD was prepared to participate in the drug-reduction programme. Although 16% succeeded in stopping ASD use, the majority was dissatisfied with the role of the GP. Improved GP support might have make more patients stop using ASD.     

Assessment of intervention strategies against a novel influenza epidemic using an individual-based model

Objectives  

The objective of this study was to assess intervention strategies against a novel influenza epidemic through simulations of various scenarios in Sapporo city, Hokkaido, Japan. A series of interventions were examined: administration of antiviral drugs by two approaches [targeted antiviral prophylaxis (TAP) and school-age targeted antiviral prophylaxis (STAP)], school closure, restraint, and combinations of these four interventions.     

Fat-sugar see-saw in school lunches: impact of a low fat intervention

PURPOSE: To determine the long-term effects of a low fat intervention on sugar content in school lunches METHODS: We calculated contributions of total sugars, 6 specific sugars, and selected nutrients in National School Lunch Program meals served in 56 former intervention, 20 randomly selected control schools that had participated 3 years before in a low fat intervention, and 12 additional schools from neighboring school districts that had never been exposed to the intervention, whose goal was the lowering of total fat to under 30% of calories and saturated fat to under 10% calories. Analysis of variance adjusted for region was used to compare treatment groups. Pearson partial correlations controlling for the effects of region and treatment group were used to assess the strength of sugar and fat relationships. RESULTS: Three years after the low fat intervention, former intervention, control and unexposed schools lunches were similar in mean total sugars (25% of calories), and "added" sugars (e.g. sucrose, glucose, galactose, and maltose) at 15% of calories; and differed only in their lactose content. As percent of calories from fat or saturated fat in lunches decreased, that from sugars increased. Lunches that met reduced saturated fat goals were significantly higher than those not meeting goals in percent of calories from sugars both in meals as offered (27.6 +/- 0.3% vs. 26.2 +/- 0.3 SE p =.004) and as served (26.5 +/- 0.4 vs. 23.9 +/- 0.4 p =.009). Lunches meeting reduced total fat goals were significantly higher only in percent of calories from sugars as served. Seventy-five percent of total sugar in lunches offered was from chocolate milk, fruit/fruit juices, and white milk. More "added" sugar came from high micronutrient foods, such as fruit, fruit juices, and chocolate milk than from desserts and entrees. CONCLUSIONS: The existence of a fat-sugar "see-saw" makes it important to emphasize substitutions of fat and saturated fat with starches and fiber in school lunches.     

Engineering controls as an intervention to reduce worker exposure

The implementation of controls to reduce worker exposure should be considered the ultimate goal of any successful industrial hygiene program. The industrial hygiene literature has consistently described a hierarchy of controls, consisting first of the engineering controls (substitution, isolation, ventilation), and followed by administrative controls (personal protective equipment, worker education, scheduling, etc.). Recently, exhaust ventilation has been the most popular form of engineering control technology for controlling exposure to airborne contaminants. The use of ventilation to control exposures is not without its problems, however, and many of these problems potentially are more severe in smaller companies. This paper proposes a new emphasis on the first control in the hierarchy, substitution. Historically, substitution has meant the substitution of a hazardous chemical or process by one that is less so. This definition is too restrictive; because of this, it is proposed instead to use the term process change, defined as the use of any process modifications that serve to reduce worker exposure. The advantages and disadvantages of the process change approach are discussed and are illustrated with case studies. © 1996 Wiley-Liss, Inc.     

Feasibility of a tailored intervention to improve preventive care use in women

BACKGROUND: Women age 50 years and older are in need of multiple preventive health care services. Despite recent improvements in rates of delivery of preventive care services, especially within managed care organizations, substantial numbers of women are still being underscreened. Efforts to improve delivery of preventive care services have often focused on one outstanding service despite the fact that patients often are in need of many services. METHODS: A total of 893 women age 50 to 55 years were mailed a self-administered survey to identify outstanding preventive health care service needs. Patients in need of three or more outstanding preventive health care services were identified from survey respondents to participate in a feasibility study evaluating a tailored, customized intervention called Tic Tac Health. RESULTS: Five-hundred ninety-one women returned the survey (67%). Four-hundred forty-eight (76%) women were in need of one or more preventive health services; 92 (16%) were in need of three or more. Twenty-two patients (24%) completed the Tic Tac Health card. The women who completed the card were similar to those who did not. CONCLUSIONS: Despite documented physician visits, presence of managed care health insurance, and a designated primary care provider, a significant number of women are still in need of multiple preventive health services. An intervention targeting multiple preventive health services was demonstrated to be both feasible and effective. Further evaluation via a randomized controlled trial should be conducted to determine if an intervention like Tic Tac Health would be an effective modality for improving rates of receipt of multiple preventive health care services.     

Empowering low-income parents with skills to reduce excess pediatric emergency room and clinic visits through a tailored low literacy training intervention

In this article, we evaluate the impact of a health literacy intervention to decrease emergency room and doctor's office visits for common childhood illness symptoms. Our education model trained low-income parents of young children (9,240 families) at 55 Head Start sites on the use of a low-literacy health book to respond to common childhood illnesses. The overall strategic framework required each Head Start site to create a Health Improvement Project to plan, successfully train, monitor, and keep the momentum through a strong follow-up with families regarding their health care decisions. The study was conducted from 2003 to 2006. Each family was tracked for 3 months prior to the training using self-report, and for 6 months afterward. The average number of emergency room and doctor visits among parents decreased 58% and 41% respectively (p < .001). Further, work days missed by the primary caretaker per year decreased 42%, and school days missed per year decreased 29% (p < .001). During the health literacy intervention, emergency room and doctor visits reported among parents decreased, as well as the number of work days and school days missed per year. Significant cost savings for the health care system can be anticipated through thoughtful broad dissemination of this training model.     

An exploratory study into Dutch consumers' experiences with implementing dietary recommendations to reduce fat intake

Background: Nutrition education messages for the Dutch public include many different dietary recommendations for reducing fat intake, e.g. use low-fat milk, reduce meat intake, etc. The purpose of this exploratory study was to assess which types of dietary recommendations are difficult to implement for consumers and which are easier. Methods: Twenty-five recommendations that are often used in educational messages were selected and classified by type of recommendation. Two classifications were used for each recommendation: the product group the recommendation relates to, and the recommended type of behavioural change. Sixty-six adults of all ages were recruited to implement as many of the recommendations as possible over a period of four weeks. Beforehand, participants completed a food frequency list to assess which recommendations they had already implemented. After the 4 weeks, they completed a written questionnaire measuring intention, implementation and perceived difficulties for each of the remaining recommendations. Results: Based on the classification according to product group, recommendations concerning spreads and butter, sauces and gravy were rated as least difficult to implement, while recommendations on snacks were most difficult to implement. As far as the type of behavioural change recommendations, preparing a product differently was easiest to implement, while recommendations to eat less of a high-fat product were considered as most difficult to implement. Conclusions: The results show that there are differences in difficulties consumers experience in implementing different types of recommendations for reducing fat intake. Further research should extend this line of inquiry to help design optimally effective nutrition interventions.     

Implementation of an online tailored physical activity intervention for adults in Belgium

It has been argued that the Internet is a promising channel for distribution of health promoting programs, because of its advantage to reach a wide variety of people at once, at any time and location. However, little research is done to study how we could prompt people to use these online health promoting programs. Therefore the main objective of the present study was to assess if a face-to-face contact stimulates adults to visit a recently developed tailored physical activity website to promote more physical activity in the general Belgian population. The second objective was to test the website under real-life conditions in a small sample. Therefore, 200 flyers, with a call for evaluating the new tailored physical activity website, were distributed to hospital visitors in two different ways. One group of visitors were personally approached by a research assistant and handed over a flyer. Another 100 visitors could simply take a flyer home, without initial personal contact. After two months, telephone interviews were done to make a qualitative evaluation of the website. The results showed that obviously more participants with an initial face-to-face contact (46%) registered on the website in comparison with the participants without personal contact (6%). The used strategy reaches participants of both sexes as well as regular and irregular Internet users. Secondly, the telephone interviews indicated that the website was accepted well, without major problems. We could conclude that distributing flyers combined with a short face-to-face contact, increased the number of visitors compared with distributed flyers without contact and that the tailored physical activity website could be used in real-life situations to promote an active lifestyle in Belgium. However, a controlled study with a larger sample size should be done to test the effectiveness of the tailored intervention in increasing physical activity.     

Why modelling a complex intervention is an important precursor to trial design: lessons from studying an intervention to reduce falls-related injuries in older people

OBJECTIVES: To develop a cost-effectiveness model of a complex intervention from pilot study data in order to inform the viability and design of a subsequent falls prevention trial.METHODS: We used two models; the first estimated the probability of falling over a 12-month period based on a probability tree; the second used Markov simulation to assess the impact of the programme over time.RESULTS: The first model indicated that our intervention would reduce the proportion falling by only 2.8% over a 12-month period. The major reason for this small effect was that less than a quarter of older people at risk of falling were assessed using our screening tool. Even if policy-makers were willing to spend 30,000 pounds per quality-adjusted life-year gained, there is only a 40% chance that the intervention would be cost-effective. Sensitivity analyses showed that the only scenarios that produced a substantial increase in the effect of the intervention were those in which all older people are assessed.CONCLUSIONS: The model-building approach described in this paper is vital when designing complex trials and where a trial is not possible. Information from the modelling can be used to re-design the intervention. The effectiveness of our proposed intervention appears very small due to its inability to reach those at risk of falling. It is most likely not to be cost-effective. If inability to reach the target group is a weakness common to other similar interventions, this suggests an area for further research.     

The efficacy of Web-based and print-delivered computer-tailored interventions to reduce fat intake: results of a randomized, controlled trial

ObjectiveTo test and compare the efficacy of interactive- and print-delivered computer-tailored nutrition education targeting saturated fat intake reduction.DesignA 3-group randomized, controlled trial (2003-2005) with posttests at 1 and 6 months post-intervention.SettingWorksites and 2 neighborhoods in the urban area of Rotterdam.ParticipantsA convenience sample of healthy Dutch adults (n = 442).InterventionsAn interactive, computer-tailored intervention delivered on a CD-ROM (interactive-tailored condition); a print-delivered, computer-tailored intervention (print-tailored condition); and print-delivered, generic information.Main Outcome MeasuresTotal and saturated fat intake (grams/day and percentage-energy) and energy intake per day assessed with validated food frequency questionnaires at 1 and 6 months post-intervention.AnalysisMultilevel linear regression analyses.ResultsMean total fat, saturated fat, and energy intakes were significantly lower in both tailored conditions compared to the generic condition at 1-month follow-up. These differences were still significant for the print-tailored condition at 6-months follow-up. Effects were most pronounced among participants with unfavorable fat intakes at baseline. There were no significant differences between the 2 tailoring conditions.Conclusions and ImplicationsThe results indicate that interactive and print-delivered computer-tailored interventions can have similar short-term effects on fat intake and that the effects of the print-delivered tailored feedback are maintained in the longer term.     

Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness

BACKGROUND: The U.S. Preventive Services Task Force (USPSTF) has recommended screening and behavioral counseling interventions in primary care to reduce alcohol misuse. This study was designed to develop a standardized rating for the clinically preventable burden and cost effectiveness of complying with that recommendation that would allow comparisons across many recommended services. METHODS: A systematic review of the literature from 1992 through 2004 to identify relevant randomized controlled trials and cost-effectiveness studies was completed in 2005. Clinically preventable burden (CPB) was calculated as the product of effectiveness times the alcohol-attributable fraction of both mortality and morbidity (measured in quality-adjusted life years or QALYs), for all relevant conditions. Cost effectiveness from both the societal perspective and the health-system perspective was estimated. These analyses were completed in 2006. RESULTS: The calculated CPB was 176,000 QALYs saved over the lifetime of a birth cohort of 4,000,000, with a range in sensitivity analysis from -43% to +94% (primarily due to variation in estimates of effectiveness). Screening and brief counseling was cost-saving from the societal perspective and had a cost-effectiveness ratio of $1755/QALY saved from the health-system perspective. Sensitivity analysis indicates that from both perspectives the service is very cost effective and may be cost saving. CONCLUSIONS: These results make alcohol screening and counseling one of the highest-ranking preventive services among the 25 effective services evaluated using standardized methods. Since current levels of delivery are the lowest of comparably ranked services, this service deserves special attention by clinicians and care delivery systems.