The efficacy and cost-effectiveness of a community weight management intervention: a randomized controlled trial of the health weight management demonstration.

PURPOSE: The study investigated the efficacy and cost-effectiveness of a cognitive-behavioral weight management program, complemented by an interactive Web site and brief telephone/e-mail coaching. METHODS: In 2006-2007, 1755 overweight, non-active-duty TRICARE beneficiaries were randomized to one of three conditions with increasing intervention intensity: written materials and basic Web access (RCT1), plus an interactive Web site (RCT2), plus brief telephone/e-mail coaching support (RCT3). The study assessed changes in weight, blood pressure, and physical activity from baseline to 6, 12, and 15-18 months. (Study retention was 31% at 12 months.) Average and incremental cost-effectiveness and cost-offset analyses were conducted. RESULTS: Participants experienced significant weight loss (-4.0%, -4.0%, and -5.3%, respectively, in each RCT group after 12 months and -3.5%, -3.8%, and -5.1%, respectively, after 15 to 18 months), increased physical activity, and decreased blood pressure. Cost-effectiveness ratios were $900 to $1100/quality-adjusted life year (QALY) for RCT1 and RCT2 and $1900/QALY for RCT3. The cost recovery period to the government was 3 years for RCTs 1 and 2 and 6 years for RCT3. CONCLUSION: A relatively inexpensive cognitive-behavioral weight management intervention improved patient outcomes. Extrapolation of savings for the entire TRICARE population would significantly reduce direct medical costs.

Menthol cigarettes contribute to the appeal and addiction potential of smoking for youth.

INTRODUCTION: Menthol cigarettes are a common choice of cigarettes among young smokers that contribute to the addictive potential of cigarette smoking. METHODS: We reviewed prior research and analyzed the 2006 National Youth Tobacco Survey (NYTS), using logistic regression to assess the relationship between menthol cigarette use and needing a cigarette within 1 hr after smoking. RESULTS: In the 2006 NYTS, 51.7% (95% CI: 45.8-57.5) of middle school smokers and 43.1% (95% C.I.: 37.0, 49.1) of high school smokers reported that they usually smoked a menthol brand of cigarettes, using a menthol smoking status definition based on consistency between smokers' report of the brand and the menthol status of the cigarettes they usually smoked. A logistic regression model of dependence, controlling for background (i.e., school level, gender, and race/ethnicity) and smoking level (i.e., years, frequency, and level of smoking) found that smoking menthol cigarettes was significantly associated with reduced time to needing a cigarette among smokers with a regular brand (odds ratio [OR]: 1.86, p = .003) and among established smokers (OR: 2.06, p = .001). This is consistent with other studies that found that youth who smoked menthol cigarettes were significantly more likely than those who smoked nonmenthol cigarettes to report signs of nicotine dependency. CONCLUSIONS: Menthol cigarettes contribute to the appeal of youth smoking and to the addictive potential of smoking cigarettes among youth. It is important to control the use of menthol cigarettes and to implement cessation strategies that are effective with youth smokers.

Building company health promotion capacity: a unique collaboration between Cargill and the Centers for Disease Control and Prevention.

BACKGROUND: The US Centers for Disease Control and Prevention (CDC) helps protect the health and safety of all people. The workplace can be used to reach millions of workers and their families with programs, policies, and benefits that promote health. We describe a CDC-led project to build Cargill's workplace health promotion capacity and identify the importance of a company liaison in the public-private relationship. CONTEXT: The project goals were to engage diverse Cargill personnel, conduct a workplace health assessment, aid in the development of a workplace health program action plan, and develop Cargill's internal capacity using knowledge and skill-building. METHODS: CDC partnered with Cargill on a workplace health promotion project to build Cargill's capacity. A multicomponent assessment was conducted to determine priority employee health issues, stakeholder meetings were held to engage and educate Cargill management and employees, and technical assistance was provided regularly between CDC and Cargill. CONSEQUENCES: Identifying a company liaison to work with an external assessment team is critical to building capacity for a successful workplace health project. This relationship creates an understanding of company culture and operations, facilitates access to key stakeholders and data, and provides opportunities to enhance capacity and sustainability. INTERPRETATION: Employers undertaking workplace health promotion projects should identify a senior-level person to serve as the company health leader or liaison and who can devote the time necessary to build trusting relationships with partners to ensure project success. This person is valuable in facilitating communications, data collection, logistical support, troubleshooting, and influencing employer workplace health practices.

Impact of the CDC's Section 317 Immunization Grants Program funding on childhood vaccination coverage.

The Centers for Disease Control and Prevention's Section 317 Grants Program is the main source of funding for state and jurisdictional immunization programs, yet no study has evaluated its direct impact on vaccination coverage rates. Therefore, we used a fixed-effects model and data collected from 56 US jurisdictions to estimate the impact of Section 317 financial assistance immunization grants on childhood vaccination coverage rates from 1997 to 2003. Our results showed that increases in Section 317 funding were significantly and meaningfully associated with higher rates of vaccination coverage; a 10 dollars increase in per capita funding corresponded with a 1.6-percentage-point increase in vaccination coverage. Policymakers charged with funding public health programs should consider this study's findings, which indicate that money allocated to vaccine activities translates directly into higher vaccine coverage rates.

Evaluating the Impact of Six Supplemental Nutrition Assistance Program Education Interventions on Children's At-Home Diets.

BACKGROUND: Nutrition education in the Supplemental Nutrition Assistance Program Education (SNAP-Ed) is designed to promote healthy eating behaviors in a low-income target population. PURPOSE: To evaluate the effectiveness of six SNAP-Ed interventions delivered in child care centers or elementary school settings in increasing participating children's at-home fruit and vegetable (F/V) consumption by 0.3 cups per day and use of fat-free or low-fat milk instead of whole or reduced-fat milk during the prior week. METHOD: Clustered randomized or quasi-experimental clustered trials took place in child care centers or elementary schools between 2010 and 2012. Parents of children at intervention and control sites completed baseline and follow-up surveys about their child's at home F/V consumption and other dietary behaviors. RESULTS: One of the six interventions was successful in meeting the objective of increasing children's F/V consumption by 0.3 cups per day. For three of the six interventions, there was a small but statistically significant increase in F/V consumption and/or use of low-fat or fat-free milk. CONCLUSION: Although not all interventions were effective, these findings suggest that it is possible for some SNAP-Ed interventions to improve dietary habits among low-income children among some families. The effective interventions appear to have benefited from implementation experience and sustained efforts at intervention refinement and improvement.

Eat Smart, Live Strong intervention increases fruit and vegetable consumption among low-income older adults.

This study evaluated the impact of a four-session interactive nutrition education program-Eat Smart, Live Strong (ESLS)-on the consumption of fruit and vegetables by low-income older adults. A pre-post quasi-experimental design study was conducted with a longitudinal sample of 614 low-income Supplemental Nutrition Assistance Program (SNAP) participants and those eligible for SNAP, aged 60 to 80 years, in 17 intervention and 16 comparison senior centers in Michigan. The study compared participants' self-reports of their consumption of fruit and vegetables using a modified version of the University of California Cooperative Extension Food Behavior Checklist. ESLS increased participants' average daily consumption of fruit by 0.2 cups (P < 0.05) and vegetables by 0.31 cups (P < 0.01). ESLS, a four-session, cognitive-behavioral nutrition education program is an effective curriculum for helping low-income older adults eat more fruit and vegetables.

Effects of front-of-package and shelf nutrition labeling systems on consumers.

As standards are considered for nutrition front-of-package (FOP) and shelf-labeling systems in the United States, it is important to know what types of systems are most effective in conveying scientifically accurate and useful information to consumers. A systematic literature review identified 38 empirical studies on consumer response to FOP nutrition labeling and shelf labeling. Studies indicate that consumers can more easily interpret and select healthier products with nutrient-specific FOP nutrition labels that incorporate text and symbolic color to indicate nutrient levels rather than nutrient-specific labels that only emphasize numeric information, such as Guideline Daily Amounts expressed as percentages and/or grams. Summary systems may influence consumers to purchase healthier products. However, more research is needed to assess the influence of nutrient-specific labels on consumers' purchases. This review identified few studies that compared consumers' ability to select healthier products using nutrient-specific systems that incorporate text and color codes with multiple-level summary icons. More research is needed to determine the effects of FOP nutrition labeling on consumers' actual shopping behaviors and dietary intakes.

A novel approach to selecting and weighting nutrients for nutrient profiling of foods and diets.

BACKGROUND: Nutrient profiling of foods is the science of ranking or classifying foods based on their nutrient composition. Most profiling systems use similar weighting factors across nutrients due to lack of scientific evidence to assign levels of importance to nutrients. OBJECTIVE: Our aim was to use a statistical approach to determine the nutrients that best explain variation in Healthy Eating Index (HEI) scores and to obtain ß-coefficients for the nutrients for use as weighting factors for a nutrient-profiling algorithm. DESIGN: We used a cross-sectional analysis of nutrient intakes and HEI scores. PARTICIPANTS: Our subjects included 16,587 individuals from the National Health and Nutrition Examination Survey 2005-2008 who were 2 years of age or older and not pregnant. MAIN OUTCOME MEASURE: Our main outcome measure was variation (R(2)) in HEI scores. STATISTICAL ANALYSES: Linear regression analyses were conducted with HEI scores as the dependent variable and all possible combinations of 16 nutrients of interest as independent variables, with covariates age, sex, and ethnicity. The analyses identified the best 1-nutrient variable model (with the highest R(2)), the best 2-nutrient variable model, and up to the best 16-nutrient variable model. RESULTS: The model with 8 nutrients explained 65% of the variance in HEI scores, similar to the models with 9 to 16 nutrients, but substantially higher than previous algorithms reported in the literature. The model contained five nutrients with positive ß-coefficients (ie, protein, fiber, calcium, unsaturated fat, and vitamin C) and three nutrients with negative coefficients (ie, saturated fat, sodium, and added sugar). ß-coefficients from the model were used as weighting factors to create an algorithm that generated a weighted nutrient density score representing the overall nutritional quality of a food. CONCLUSIONS: The weighted nutrient density score can be easily calculated and is useful for describing the overall nutrient quality of both foods and diets.

Systematic review of public health branding.

Brands build relationships between consumers and products, services, or lifestyles by providing beneficial exchanges and adding value to their objects. Brands can be measured through associations that consumers hold for products and services. Public health brands are the associations that individuals hold for health behaviors, or lifestyles that embody multiple health behaviors. We systematically reviewed the literature on public health brands; developed a methodology for describing branded health messages and campaigns; and examined specific branding strategies across a range of topic areas, campaigns, and global settings. We searched the literature for published studies on public health branding available through all relevant, major online publication databases. Public health branding was operationalized as any manuscripts in the health, social science, and business literature on branding or brands in health promotion marketing. We developed formalized decision rules and applied them in identifying articles for review. We initially identified 154 articles and reviewed a final set of 37, 10 from Africa, Australia, and Europe. Branded health campaigns spanned most of the major domains of public health and numerous communication strategies and evaluation methodologies. Most studies provided clear information on planning, development, and evaluation of the branding effort, while some provided minimal information. Branded health messages typically are theory based, and there is a body of evidence on their behavior change effectiveness, especially in nutrition, tobacco control, and HIV/AIDS. More rigorous research is needed, however, on how branded health messages impact specific populations and behaviors.

Reducing children's television-viewing time: a qualitative study of parents and their children.

OBJECTIVES: The American Academy of Pediatrics recommends that children over age 2 years spend < or = 2 hours per day with screen media, because excessive viewing has been linked to a plethora of physical, academic, and behavioral problems. The primary goal of this study was to qualitatively explore how a recommendation to limit television viewing might be received and responded to by a diverse sample of parents and their school-age children. METHODS: The study collected background data about media use, gathered a household media inventory, and conducted in-depth individual and small group interviews with 180 parents and children ages 6 to 13 years old. RESULTS: Most of the children reported spending approximately 3 hours per day watching television. The average home in this sample had 4 television sets; nearly two thirds had a television in the child's bedroom, and nearly half had a television set in the kitchen or dining room. Although virtually all of the parents reported having guidelines for children's television viewing, few had rules restricting the time children spend watching television. Data from this exploratory study suggest several potential barriers to implementing a 2-hour limit, including: parents' need to use television as a safe and affordable distraction, parents' own heavy television viewing patterns, the role that television plays in the family's day-to-day routine, and a belief that children should spend their weekend leisure time as they wish. Interviews revealed that for many of these families there is a lack of concern that television viewing is a problem for their child, and there remains confusion about the boundaries of the recommendation of the American Academy of Pediatrics. CONCLUSIONS: Parents in this study expressed interest in taking steps toward reducing children's television time but also uncertainty about how to go about doing so. Results suggest possible strategies to reduce the amount of time children spend in front of the screen.

Are menthol cigarettes a starter product for youth?

This study assessed the relationship between menthol use and nicotine dependence. Data from the National Youth Tobacco Survey indicated that menthol cigarette use was significantly more common among newer, younger smokers. Additionally, youth who smoked menthol cigarettes had significantly higher scores on a scale of nicotine dependence compared with nonmenthol smokers, controlling for demographic background and the length, frequency, and level of smoking. The study suggests that menthol cigarettes are a starter product that may be associated with smoking uptake by youth.

Getting to the truth: evaluating national tobacco countermarketing campaigns.

OBJECTIVES: This study examines how the American Legacy Foundation's "truth" campaign and Philip Morris's "Think. Don't Smoke" campaign have influenced youths' attitudes, beliefs, and intentions toward tobacco. METHODS: We analyzed 2 telephone surveys of 12- to 17-year-olds with multivariate logistic regressions: a baseline survey conducted before the launch of "truth" and a second survey 10 months into the "truth" campaign. RESULTS: Exposure to "truth" countermarketing advertisements was consistently associated with an increase in anti-tobacco attitudes and beliefs, whereas exposure to Philip Morris advertisements generally was not. In addition, those exposed to Philip Morris advertisements were more likely to be open to the idea of smoking. CONCLUSIONS: Whereas exposure to the "truth" campaign positively changed youths' attitudes toward tobacco, the Philip Morris campaign had a counterproductive influence.

The effects of state counterindustry media campaigns on beliefs, attitudes, and smoking status among teens and young adults.

OBJECTIVES: This study sought to identify the pathways through which state-funded counterindustry media campaigns influence beliefs and attitudes regarding tobacco industry practices and smoking status. METHODS: A national random-digit-dial telephone survey of 6875 youths 12 to 24 years old was conducted in Winter 1999-2000. Exploratory and confirmatory factor analysis investigated the structure underlying beliefs and attitudes toward the tobacco industry. Structural equation modeling tested whether the data were consistent with a theoretically based causal model of campaign effects from exposure to an aggressive counterindustry campaign, mediated by beliefs about tobacco industry practices and attitudes toward the tobacco industry, to smoking status. RESULTS: Exploratory and confirmatory factor analysis indicated that two dimensions underlie perceptions of the tobacco industry: beliefs about tobacco industry practices and attitudes toward the industry. Structural equation models provided strong support for the hypothesized model: youth living in states with aggressive counterindustry media campaigns had more negative beliefs about tobacco industry practices, which led to negative attitudes toward the industry and less progression along a continuum of smoking intentions and behavior. CONCLUSIONS: Media campaigns using counterindustry messages show promise in reducing smoking behavior among teens and young adults by changing beliefs about industry practices.