Stage-matched nutrition guidance for patients at elevated risk for cardiovascular disease: a randomized intervention study in family practice

OBJECTIVE: To examine stage-matched nutrition counseling by family physicians and its effect on dietary intake, anthropometry, and serum lipid levels in patients at elevated risk for cardiovascular disease. METHODS: In this controlled trial, patients randomized to intervention practices received nutrition information following the Stages-of-Change Model, and patients randomized to control practices received usual care. RESULTS: At both 6 and 12 months after baseline, total fat intake and saturated fat intake declined significantly more in the intervention group than in the control group: -5.7% and -2.6% of energy, respectively, at 6 months, and -3.6% and -1.7% of energy, respectively, at 12 months. For energy intake, body weight, and BMI, there were significant differences between groups only at 6 months: -0.8 megajoules (MJ), -0.7 kg, and -0.3 kg/m(2), respectively. None of the serum lipid values changed significantly between groups at 12 months. CONCLUSIONS: Nutritional counseling based on stages of change led to reductions in dietary fat intake and weight loss in the short term. However, we found no corresponding changes in serum lipid concentrations.     

Stages of dietary change and nutrition attitudes in the Spanish population

A national survey was developed in a representative sample of the Spanish population (15 years old and upwards). This study belongs to a partnership in a pan-European survey about stages of dietary change where subjects were classified into six different categories according to their readiness for dietary change: precontemplation (not considering any changes), contemplation (considering changes), decision (making plans to change), action (carrying out the changes), maintenance (maintaining changes for more than six months) and relapse stage (reverting back to eating less healthily). The main objective was to investigate the distribution of the different stages of change concerning dietary habits across strata of socio-demographic variables (sex, age, educational level, socioeconomic level). Also, this study was conducted to assess the relationships between stages of dietary change and the influences on food choice as well as the definitions used to describe healthy eating. The survey was carried out, according to an established protocol, on a representative sample of 1009 Spanish subjects selected by an at random multistage procedure. Subjects completed a face-to-face interview-assisted questionnaire. To ensure representativeness data were weighted by population size, by sex, age and regional distribution. The proportion of subjects in precontemplation (56.0%) and maintenance (28.3%) stages was substantially larger than in the other stages of dietary change. More males (59.7%) and subjects from the oldest age groups (65.8%) were classified as belonging to the precontemplation stage, while more females (30.2%) and subjects between 25-34 years of age (34.5%) were in the maintenance stage. 'Trying to eat healthy' as an influence on food choice was more frequently mentioned by those in the dynamic and maintenance stages, while a high percentage of subjects from the precontemplation and relapse stages (61.1%) agreed they did not need to make changes to their diets because their diet was already sufficiently healthy. A very high proportion of the Spanish adult population do not contemplate a change in their dietary habits. Intervention strategies in health promotion programs should be available for people at the various stages of change. It would be more effective to attempt to increase people's awareness and personal concerns about nutrition and health, before introducing action strategies. Implications for research and practice: The adult population can be classified into different stages of dietary change, so the stages of change model may be applied to future nutrition interventions. This approach will help to focus more accurately strategies of nutrition education.     

Food safety knowledge and practice by the stages of change model in school children

In this study, 342 grade 4-6 elementary school students in Gyeonggi-do were recruited to determine their readiness to change food safety behavior and to compare their food safety knowledge and practices by the stages of change. The subjects were divided into three stages of change; the percentage of stage 1 (precontemplation) was 10.1%, the percentage of stage 2 (contemplation and preparation) was 62.4%, and that of stage 3 (action and maintenance) was 27.5%. Food safety knowledge scores in stage 3 (4.55) or stage 2 (4.50) children were significantly higher than those in stage 1 children (4.17) (P < 0.05). The two food safety behavior items "hand washing practice" and "avoidance of harmful food" were significantly different among the three groups (P < 0.05). Stages of change were significantly and positively correlated with food safety knowledge and practice. Age was significantly and negatively correlated with the total food safety behavior score (r = -0.142, P < 0.05). The most influential factor on the stage of change was a mother''s instruction about food safety (P < 0.01).     

The effects of food safety education on adolescents' hand hygiene behavior: an analysis of stages of change

The hand hygiene behavior of 400 middle school students (grades 1-3) in Seoul and Gyeonggi-Do was studied to determine how stages of change were affected by food safety education, focusing on hand hygiene and general food safety. Subjects were 51.3% male and 44.3% of study subjects were first graders of middle school. Approximately 40% of subjects were at the stage of action, 42.7% were at the stage of contemplation, and 16.4% were at pre-contemplation. The most important factor that influenced proper hand washing was self efficacy (P < 0.001). Proper hand washing was also correlated significantly with positive belief (P < 0.01) and stages of change (P < 0.01). After food safety education by high-school mentors, middle-school students who were in the stages of pre-contemplation (11.1%) and contemplation (88.9%) showed significant progression toward the action stage (P < 0.001). Proper hand washing (P < 0.01) and food safety knowledge (P < 0.05) were also significantly increased after educational intervention.     

农村居民慢性病危险因素SOC模型干预效果评价

目的应用SOC模型探索科学、有效的人群行为干预方法,评估其慢性病危险因素干预效果。方法选取干预组与对照组各500人,按SOC模型对其健康行为的接受程度划分为5个阶段,对干预组不同阶段人群进行有针对性的健康干预,在干预末期评估2组行为改变及血压及生化指标改变。结果干预后干预社区前后及与对照社区比较,干预社区农民对健康生活方式的认知程度明显改善;吸烟率、饮酒率分别由33.6%、50.2%下降到21.3%、33.6%(P<0.05);平均每天锻炼时间、膳食结构明显改善;干预社区农民BM I收缩压、舒张压、血中总胆固醇分别由(24.07±4.16)、(124.90±20.66)、(81.47±13.53)mm Hg(1 mm Hg=0.133 kPa)和(5.43±1.12)mmol/L下降到(23.69±3.15)、(122.89±15.36)、(79.37±9.39)mm Hg和(4.87±0.82)mmol/L(P<0.05)。结论 SOC模型对农民进行慢性病危险因素干预效果明显。     

A comparison of different approaches to promote community-wide dietary change

BACKGROUND: Because public health education funds are limited, it is important to determine which methods are most effective for promoting healthy lifestyles to communities. We conducted interventions in two communities to further examine the effectiveness of various educational approaches for communicating the "1% Or Less" message to switch from high-fat (whole or 2%) to low-fat (1% or fat-free) milk. METHODS: One intervention used public relations and community-based educational activities in supermarkets, schools, worksites, and other community settings. The other used paid advertising in the absence of other programming. We used telephone surveys and supermarket milk sales data, collected before and after each campaign and in a comparison community, to determine changes in milk-usage patterns. RESULTS: After the campaign of community-based educational programs and public relations activities, the proportion of high-fat milk drinkers who reported drinking low-fat milk was 19.6% compared with 6.8% for the comparison city (p<0.0001). After the advertising-only campaign, 12.8% of high-fat milk drinkers reported drinking low-fat milk (p<0.01). Although supermarkets experienced increases in low-fat milk sales after both campaigns, the results were not statistically significant. CONCLUSIONS: The results show how well-designed public relations activities can attract news coverage and provide further evidence that such coverage can be an important component of health-promotion campaigns. Although the use of paid advertising in the absence of other media or programming appeared to change milk-drinking habits, the results were not sustained after the ads stopped airing.     

Developing a nutrition and health education program for primary schools in Zambia

School-based health and nutrition interventions in developing countries aim at improving children’s nutrition and learning ability. In addition to the food and health inputs, children need access to education that is relevant to their lives, of good quality, and effective in its approach. Based on evidence from the Zambia Nutrition Education in Basic Schools (NEBS) project, this article examines whether and to what extent school-based health and nutrition education can contribute directly to improving the health and nutrition behaviors of school children. Initial results suggest that gains in awareness, knowledge and behavior can be achieved among children and their families with an actively implemented classroom program backed by teacher training and parent involvement, even in the absence of school-based nutrition and health services.     

Psychosocial factors and eating behaviors according to the stages of change in nutrition management among elementary and middle school athletes

BACKGROUND/OBJECTIVESThis study examined the differences in psychosocial factors and eating behaviors by the stages of change (SOC) in nutrition management among elementary and middle school athletes.SUBJECTS/METHODSSubjects were young athletes recruited from the athletic clubs of 10 organizations. Subjects responded to a survey questionnaire, and data on 167 athletes were analyzed. Subjects were grouped into the pre-action or action stage in nutrition management. The χ² test, t-test, analysis of covariance, and correlation analysis were used in data analysis.RESULTSAthletes in the action stage (62.3%) compared to the pre-action stage, showed a higher self-efficacy (P < 0.01), and felt more confidence in performing specific eating behaviors (P < 0.05 to P < 0.01). Those in the action stage had more favorable beliefs regarding nutrition (P < 0.001) and agreed less strongly on the specific misconceptions/disadvantages of nutrition (P < 0.01) than those in the pre-action stage. Eating behaviors (P < 0.001) and subscales of the eating behaviors (P < 0.05 to P < 0.01) also differed significantly by the SOC group. Place of eating dinner (P < 0.05) and the person who prepares dinner (P < 0.05) showed significant differences by the SOC group. The relationship of self-efficacy, beliefs regarding nutrition, and eating behaviors to the SOC differed by sports type. Beliefs for football athletes, self-efficacy, and beliefs for baseball athletes were correlated significantly with the SOC, whereas all 3 variables were related to the SOC for handball and other athletes.CONCLUSIONSThis study showed differences in psychosocial factors and eating behaviors between the pre-action and action stages. Nutrition education should include strategies to help young athletes modify their beliefs, mainly misconceptions/disadvantages of nutrition, increase self-efficacy, and adopt specific and desirable eating behaviors. Nutrition education might employ different strategies considering the sports type that student-athletes participate.     

Developments in nutrition labelling legislation: a major issue for dietitians and corporate nutritionists

The paper reviews the types of nutrition information currently used in food labelling and advertising. An update is given on the existing and proposed guidelines and legislation which aim to prevent misleading nutrition information and ensure that such information benefits the consumer. The efficacy of these controls will be a major factor determining whether autrition labelling can be of value in health education in the 1990s.     

Treating obesity: can the stages of change model help predict outcome measures?

Background: The transtheoretical model of behaviour change the ‘Stages of Change’ by Prochaska & Di Clemente (1982) has been advocated for enhancing dietary counselling. It has been suggested that understanding where people are in the stages of change model could lead to targeting of advice and improved outcome of dietetic management such as weight loss in the obese and reduced did not attend rates. This study assessed whether a six-question staging model of the stages of change could predict which patients are most likely to not attend an appointment and predict those who will lose weight. Methods: Prior to the start of their dietetic interview, obese outpatients completed a simple ‘stages of change questionnaire’ (SCQ). This assessed where the patient was in the stage of change cycle, motivation to lose weight, how easy they thought this would be and attendance rate. Patients who did not attend were sent a SCQ in the post. Results: There were no significant differences in SCQ scores at visit one, between patients attending twice (group 1) and those who did not attend their second appointment (group 2). By visit two, 72% of group 1 who were in the action or maintenance stage of the cycle had lost 1.5±2.4% body weight, and were more optimistic and committed to doing so. There was no correlation between percentage weight loss and the first SCQ score in group 1 (r=0.05, P=0.73). It is of interest that no subject in group 3, i.e. those who did not attend both appointments, returned any of the SCQs after the first mailing and only 17% of this group returned one after a reminder was sent. Conclusion: Evidence from this study would suggest that the stages of change model does not distinguish between which patients will not attend a second appointment or lose weight. However, it may help identify motivated patients if used as a postal screening tool.     

Effects of a school-based nutrition program diffused throughout a large urban community on attitudes, beliefs, and behaviors related to fruit and vegetable consumption

BACKGROUND: Obesity among US children has increased in recent years. Although increased fruit and vegetable consumption has not been directly linked to obesity prevalence, it has been posited that more fruits and vegetables (FV) could reduce the consumption of high‐fat, energy‐dense foods and may protect against childhood illnesses including asthma and other respiratory diseases. The purpose of this current research was to assess the impact of a large public school district's hybrid approach to nutrition education programming on attitudes, beliefs, and behaviors related to fruit and vegetable consumption. METHODS: A total of 12 elementary schools from the Los Angeles Unified School District (9 intervention schools, 3 control schools) were randomly selected to participate in a “hybrid” school‐based nutrition education program. Data were collected at baseline (beginning of school year) and postintervention data (end of school year 9 months later). Linear mixed models were developed to assess the impact of the intervention. RESULTS: The intervention resulted in a significant change in teacher influence on students' attitudes toward FV (p < .05) and students' attitudes toward vegetables (p < .01), even after adjusting for gender, grade, and race/ethnicity. Although not statistically significant, there was a slight increase in fruit and vegetable consumption from pretest to posttest for both the intervention and control schools. CONCLUSION: The hybrid model reflects a more accurate representation of school‐based interventions. More research is needed to identify the specific components of this model that are most successful in impacting fruit and vegetable consumption among US children.     

Changing nutrition standards in schools: the emerging impact on school revenue

BACKGROUND: Although great focus has been placed on nutritional and other consequences of changes in food-related policies within schools, few reports exist describing the impact of such changes on school revenue. This review provides an overview of the few revenue-related studies published recently, as well as information from a sampling of state reports on the subject. METHODS: A systematic review of the literature was conducted. Four peer-reviewed papers and 3 state-based reports were identified that assessed the impact on revenues of either targeted policy changes or overarching, district-wide changes in food-related policies. RESULTS: Thus far, few data exist to substantiate the concern that changes in nutrition standards in schools lead to a loss in total revenue. An interesting phenomenon of increased participation in the National School Lunch Program was noted in a number of reports and might play a role in buffering financial losses. CONCLUSIONS: A renewed focus on school policies related to health provides the opportunity for researchers to investigate how nutrition-related policy change can affect, if at all, food service and overall school revenues.     

对贫困地区儿童实施“营养课堂”效果评价

目的 了解延边贫困地区儿童对营养知识、态度及膳食行为现况, 评价以“营养课堂”形式的干预措施对儿童营养知识、态度及膳食行为的影响效果。方法 采用随机抽样和整群抽样相结合的方法, 在延边地区抽取两所学校作为研究对象, 开展“营养课堂”, 并实施干预前后进行变化比较, 以评价其效果。结果 干预后两组的营养知识和膳食行为改变量差异有统计学意义(P＜0.05);干预组的营养态度变化在干预前后有统计学意义(P=0.000)。结论 以“营养课堂”为主的干预模式对于儿童营养知识、态度及膳食行为改变效果明显。     

Associations between Digital Health Intervention Engagement and Dietary Intake: A Systematic Review

There has been a proliferation of digital health interventions (DHIs) targeting dietary intake. Despite their potential, the effectiveness of DHIs are thought to be dependent, in part, on user engagement. However, the relationship between engagement and the effectiveness of dietary DHIs is not well understood. The aim of this review is to describe the association between DHI engagement and dietary intake. A systematic search of four electronic databases and grey literature for records published before December 2019 was conducted. Studies were eligible if they examined a quantitative association between objective measures of engagement with a DHI (subjective experience or usage) and measures of dietary intake in adults (aged ≥18 years). From 10,653 citations, seven studies were included. Five studies included usage measures of engagement and two examined subjective experiences. Narrative synthesis, using vote counting, found mixed evidence of an association with usage measures (5 of 12 associations indicated a positive relationship, 7 were inconclusive) and no evidence regarding an association with subjective experience (both studies were inconclusive). The findings provide early evidence supporting an association between measures of usage and dietary intake; however, this was inconsistent. Further research examining the association between DHI engagement and dietary intake is warranted.     

Impact of diet-related cancer prevention messages written with cognitive and affective arguments on message characteristics, stage of change, and self-efficacy

OBJECTIVE: To determine if participants reading messages matched to a preferred style of message argument respond more favorably than participants reading unmatched messages. DESIGN: Randomized trial using telephone and in-person surveys and cognitive response interviews. SETTING: University campus. PARTICIPANTS: Of 125 initially interested, a convenience sample of 100 university employees completed the study (female: 88%, white: 94%, mean age: 43.7). INTERVENTION(S): Participants read 2 print messages written with cognitive (COG) (fact based) or affective (AFF) (story based) arguments. MAIN OUTCOME MEASURE(S): 7-point Likert scale ratings of message appeal, understandability, persuasiveness, and relevance according to classification into 1 of 4 message groups: COG-AFF (mismatched to affective), AFF-COG (mismatched to cognitive), COG-COG (matched cognitive), and AFF-AFF (matched affective). ANALYSIS: 1-way analysis of variance (P < or = .05) and systematic review of qualitative interviews. RESULTS: The COG-AFF group consistently gave the lowest ratings to the affective messages and the AFF-COG group generally gave high scores compared with other message groups. Participants also expressed a desire for more factual information. CONCLUSIONS AND IMPLICATIONS: A combination of cognitive and affective arguments may be appealing to subjects with an affective preference but disliked by individuals who prefer only a fact-based approach. Argument format may be an important message design consideration.     

高年级小学生营养与食品知识认知及饮食行为调查

目的 了解长治市城区4~6年级小学生营养与食品相关知识知晓情况和饮食习惯,为下一步健康教育提供依据。方法 采用随机整群抽样的方法于2013年9-12月抽取长治市城区8所小学4~6年级的1 265名小学生进行《小学生营养与食品安全知识行为问卷》的自填式问卷调查。结果 调查对象营养与食品安全知识得分偏低,其中营养知识调整得分低于食品知识得分,差异有统计学意义(t=29.37,P<0.001)。营养知识得分六年级学生高于四五年级的学生(F=15.600,P<0.001),独生子女得分高于非独生子女(t=19.280,P<0.001)。食品知识得分女生高于男生(t=2.840,P=0.005)。有70.7%的小学生每天吃早餐;21.7%和36.0%的小学生可以保证每天吃鸡蛋和奶类;53.9%的小学生每天可以吃水果,而39.6%和24.1%小学生会吃油炸食物和腌制食物超过一周一次; 29.0%和29.9%的小学生会吃烧烤食品和膨化食物超过一周一次。小学生实际获得知识途径前两位为电视网络(49.2%)、父母(25.4%)。而小学生更愿意通过讲座(43.5%)、网络途径(40.0%)获得相关知识。结论 调查对象营养与食品安全知识掌握程度偏低,存在一些不良的饮食习惯,亟需通过健康教育来进行干预,提高调查对象的健康水平。     

Use of the youth risk behavior survey to monitor trends for nutrition and physical activity in a Midwest city school district

BACKGROUND: The Youth Risk Behavior Survey (YRBS) was used by a city school district (approximately 11,000 students) in the upper Midwest to monitor trends for nutrition and physical activity (PA) behaviors both within and between years and to compare with national 2003 data. METHODS: Independent random samples were obtained in 1999 (387 middle school [MS] and 931 high school [HS]), in 2001 (322 MS and 367 HS), and in 2003 (658 MS and 1026 HS). A two-sample test of proportions was used. RESULTS: Within each survey year, a higher proportion of MS compared to HS reported positive behaviors with some exceptions: (1) an increased proportion of HS having daily physical education (PE) and (2) a reduced proportion of HS reporting media time. Within 2003, a lower proportion of district females compared to males (MS and HS) reported participation in many measured behaviors. District trends overtime indicated a reduced proportion: (1) drinking milk (MS and HS), (2) eating breakfast (HS), and (3) watching television (MS). Trends overtime indicated an increased proportion: (1) using computers for fun (MS and HS), (2) participating in moderate PA (MS), and (3) daily PE (HS). District HS compared to national (2003) indicated a higher proportion: (1) drinking milk, (2) getting moderate PA, and (3) taking daily PE. District HS compared to national indicated a lower proportion: (1) at risk of overweight, (2) overweight, and (3) watching television. CONCLUSIONS: Analysis of district YRBS trends provides both a database for informed decisions by the school district and an assessment model for other districts.     

Unraveling the web: an evaluation of the content quality, usability, and readability of nutrition web sites

OBJECTIVE: To determine the content quality, general readability, and usability characteristics of consumer nutrition information on the World Wide Web. DESIGN: Almost 500 Web sites were identified for evaluation through 2 different approaches. Of these, 150 were included for further evaluation. Each site was rated on a 27-item tool covering content quality, readability, and usability. ANALYSIS: Summary statistics, means, ranges, and standard deviation were calculated for each study variable. The statistical significance of differences between item means by search strategy was determined using Student's t tests. RESULTS: Web sites identified using popular search engines scored significantly lower for content quality (P < .0001), were easier to navigate (P < .001), had better overall adherence to usability standards (P < .0001), and had lower reading levels compared with those sites identified using a government Web portal. CONCLUSIONS AND IMPLICATIONS: Nutrition Web sites obtained using popular search engines may be aesthetically appealing and easy to use, but they often provide inaccurate nutrition information. As consumers increasingly turn to the World Wide Web for nutrition advice and education, it is imperative that the needs of diverse user populations be identified and addressed. Future nutrition education research should build on these findings by creating strategies that help users find reliable user-friendly gateways to accurate nutrition information on the Internet.