Healthy Eating for Life English as a second language curriculum: primary outcomes from a nutrition education intervention targeting cancer risk reduction.

We conducted a pre-post feasibility trial of Healthy Eating for Life, a theory-based, multimedia English as a second language curriculum that integrates content about healthy nutrition into an English language learning program to decrease cancer health disparities. Teachers in 20 English as a second language classrooms delivered Healthy Eating for Life to 286 adult English as a second language students over one semester. Postintervention data are available for 227 students. The results indicated that Healthy Eating for Life is effective for increasing fruit and vegetable intake as well as knowledge, action planning, and coping planning related to healthy eating. Participants also achieved higher reading scores compared to the state average.

Testing messages to encourage discussion of clinical trials among cancer survivors and their physicians: examining monitoring style and message detail.

Encouraging cancer survivors to discuss clinical trials with their physicians may increase enrollment in clinical trials. Health messages offer one method for encouraging such discussions. We hypothesized that matching messages to an individual's preference for detailed or non-detailed information (i.e., monitoring style) would result in more discussions. Participants (N = 538) were cancer survivors, who phoned the National Cancer Institute's Cancer Information Service (CIS). Participants were classified as higher or lower monitors and then randomized to receive detailed or non-detailed messages in the mail 1 and 4 weeks following their baseline CIS call. At 12 weeks, there was a significant interaction between monitoring style and message detail. Follow-up analyses were nonsignificant but suggested a theoretically consistent pattern in which non-detailed messages were more effective among lower monitors. These findings imply that providing extremely detailed information may be excessive, even to individuals engaged in information seeking behavior.

Changes in traditional chronic disease risk factors over time and their relationship with leisure-time physical activity in people living with spinal cord injury.

This study examined whether levels of chronic disease risk factors change over time, and whether leisure-time physical activity (LTPA) can explain any of the variation in those risk factors that change, in a sample of community-dwelling people living with spinal cord injury (SCI) in or near Hamilton, Ontario, Canada. LTPA was measured using the Physical Activity Recall Assessment for People with SCI at baseline (n = 76 adults with chronic (≥1 year) paraplegia or tetraplegia), at 6 months (n = 71) and at 18 months (n = 63). Body mass index, waist circumference at the lowest rib (WC(lowest rib)) and iliac crest (WC(iliac crest)), fat mass, blood pressure, and biochemical data were collected at all 3 time points. Women's BMI was higher at baseline (least square means (LSM) = 26.2 ± SE = 1.56 kg·m(-2), p = 0.0004) and 6 months (25.9 ± 1.6, p = 0.0024) than at 18 months (22.1 ± 1.72). Men's WC(lowest rib) increased from baseline (92.1 ± 1.87 cm) to 18 months (93.6 ± 1.87, p = 0.0253). Women who were active vs. inactive at baseline had a lower BMI at 6 months (23.1 ± 2.91 vs. 29.7 ± 2.52, p = 0.0957) and WC(iliac crest) at 6 months (82.8 ± 6.59 vs. 97.7 ± 5.10, p = 0.0818). Women who were active vs. inactive at 6 months had a lower WC(iliac crest) at 18 months (73.4 ± 14.3 vs. 102.5 ± 6.41, p = 0.0723). There was little change in traditional risk factors over 18 months. Future studies should extend beyond 18 months in a larger sample, and explore traditional vs. novel risk factors and onset of cardiovascular disease and diabetes in the SCI population.

Formative research for a community-based message-framing intervention.

OBJECTIVE: To inform a community-based message framing intervention encouraging physical activity and fruit and vegetable consumption among medically underserved adults. METHOD: Key informant interviews, focus groups, and a survey were conducted with limited-literacy Hispanics in the northeastern United States. RESULTS: Barriers to healthy lifestyle behaviors exist at individual, community, and policy levels. A strong degree of networking among local organizations and elected officials exists that can be used to encourage healthy lifestyle initiatives. CONCLUSIONS: Community-based health communication interventions must address neighborhood realities, the literacy levels of the target population, and existing networks of providers and consumers.

Targeted smoking cessation messages for adolescents.

PURPOSE: To develop and to conduct a preliminary evaluation of smoking cessation messages targeted for adolescents. METHOD: We (a) conducted a formative evaluation to identify the optimal content and presentation approach for adolescent-targeted smoking cessation messages, (b) developed two smoking cessation videos catering to adolescent smokers' message preferences, and (c) copy tested the videos to determine the optimal message frame (gain vs. loss) using a quasi-experimental crossover design. RESULTS: In the formative evaluation, adolescent smokers preferred peer-delivered cessation messages that emphasized long-term health consequences and some social and short-term health consequences of smoking. The information from the formative evaluation was used to create a gain- (emphasized the benefits of quitting and joining a smoking cessation program) and a loss-framed video (emphasized the cost of continuing to smoke and consequences of failing to join a smoking cessation program). The copy test of the videos indicated that adolescents found the messages clear and appealing. The gain-framed message was considered more novel than the loss-framed message and was preferred by most participants. Nonetheless, the loss-framed version resulted in more positive attitudes toward quitting than the gain-framed version. CONCLUSION: Little is known about how to construct effective smoking cessation messages tailored specifically for adolescent smokers. The study findings provide insight into adolescents' preferences for message content and presentation. Although considered less novel, providing loss-framed information may be most influential among adolescents. These findings have important implications for developing effective adolescent-targeted smoking cessation messages.

Risky business: risk information and the moderating effect of message frame and past behaviour on women's perceptions of the Human Papillomavirus vaccine.

The effect of response cost information, message framing and past behaviour on women's coping appraisal and motivation to be vaccinated against the Human Papillomavirus (HPV) were investigated using a 2 Frame × 2 Response Cost × 2 Pap Status design. Women (N = 286) read one of four messages about the vaccine. Women who received high-risk information perceived the vaccine as having higher response cost and were less motivated to be vaccinated compared to women who received low-risk information. The deleterious effects of risk information on specific aspects of women's coping appraisal may be mitigated by appropriately framed messages.

New Canadian physical activity guidelines.

The Canadian Society for Exercise Physiology (CSEP), in cooperation with ParticipACTION and other stakeholders, and with support from the Public Health Agency of Canada (PHAC), has developed the new Canadian Physical Activity Guidelines for Children (aged 5-11 years), Youth (aged 12-17 years), Adults (aged 18-64 years), and Older Adults (aged >=65 years). The new guidelines include a preamble to provide context and specific guidelines for each age group. The entire guideline development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process; we based the recommendations herein on evidence from 3 systematic reviews, and the final guidelines benefitted from an extensive online and in-person consultation process with hundreds of stakeholders and key informants, both domestic and international. Since 2006, the products of our efforts resulted in the completion of 21 peer-reviewed journal articles (including 5 systematic reviews) that collectively guided this work. The process that Canadian researchers undertook to update the national physical activity guidelines represents the most current synthesis, interpretation, and application of the scientific evidence to date.

Nicotine dependence as a moderator of a quitline-based message framing intervention.

High nicotine dependence is a reliable predictor of difficulty quitting smoking and remaining smoke-free. Evidence also suggests that the effectiveness of various smoking cessation treatments may vary by nicotine dependence level. Nicotine dependence, as assessed by Heaviness of Smoking Index baseline total scores, was evaluated as a potential moderator of a message-framing intervention provided through the New York State Smokers' Quitline (free telephone based service). Smokers were exposed to either gain-framed (n=810) or standard-care (n=1222) counseling and printed materials. Those smoking 10 or more cigarettes per day and medically eligible were also offered a free 2-week supply of nicotine patches, gum, or lozenge. Smokers were contacted for follow-up interviews at 3 months by an independent survey group. There was no interaction of nicotine dependence scores and message condition on the likelihood of achieving 7-day point prevalence smoking abstinence at the 3-month follow-up contact. Among continuing smokers at the 3-month follow-up, smokers who reported higher nicotine dependence scores were more likely to report smoking more cigarettes per day and this effect was greater in response to standard-care messages than gain-framed messages. Smokers with higher dependence scores who received standard-care messages also were less likely to report use of nicotine medications compared with less dependent smokers, while there was no difference in those who received gain-framed messages. These findings lend support to prior research demonstrating nicotine dependence heterogeneity in response to message framing interventions and suggest that gain-framed messages may result in less variable smoking outcomes than standard-care messages.

A systematic review of three approaches for constructing physical activity messages: What messages work and what improvements are needed?

BACKGROUND: To motivate individuals to adhere to a regular physical activity regime, guidelines must be supplemented with persuasive messages that are disseminated widely. While substantial research has examined effective strategies for disseminating physical activity messages, there has been no systematic effort to examine optimal message content. This paper reviews studies that evaluate the effectiveness of three approaches for constructing physical activity messages including tailoring messages to suit individual characteristics of message recipients (message tailoring), framing messages in terms of gains versus losses (message framing), and targeting messages to affect change in self-efficacy (i.e., a theoretical determinant of behavior change). METHODS: We searched the MEDLINE, PsycINFO, EMBASE and CINAHL databases up to July 2008. Relevant reference lists also were searched. We included intervention trials, field experiments, and laboratory-based studies that aimed to test the efficacy or effectiveness of tailored messages, framed messages and self-efficacy change messages among healthy adults. We used a descriptive approach to analyze emerging patterns in research findings. Based on this evidence we made recommendations for practice and future research. RESULTS: Twenty-two studies were identified. Twelve studies evaluated message tailoring. In 10 of these studies, tailored messages resulted in greater physical activity than a control message. Six studies evaluated framed messages. Five of these studies demonstrated that gain-framed messages lead to stronger intentions to be active compared to a control message. Moreover, a gain-frame advantage was evident in three of the four studies that assessed physical activity. Four studies evaluated self-efficacy change messages. The two studies that used an experimental design provide a clear indication that individuals' beliefs can be affected by messages that incorporate types of information known to be determinants of self-efficacy. Overall, strong evidence to support definitive recommendations for optimal message content and structure was lacking. CONCLUSIONS: Additional research testing the optimal content of messages used to supplement physical activity guidelines is needed. Tailored messages, gain-framed messages, and self-efficacy change messages hold promise as strategies for constructing physical activity messages and should be a focus of future research.

Nicotine dependence as a moderator of message framing effects on smoking cessation outcomes.

BACKGROUND: The persuasiveness of gain-framed and loss-framed messages for smoking cessation may vary by smokers' characteristics. Preliminary research in non-treatment-seeking smokers has shown that level of nicotine dependence moderates the effects of framed smoking messages on quit intentions and smoking cessation attitudes. Nicotine dependence as a potential moderator of message framing effects on actual smoking outcomes among treatment-seeking smokers remains to be determined. PURPOSE: This secondary analysis of data from a smoking cessation trial (Psychol Addict Behav. 2007; 21: 534-544) examined nicotine dependence as a moderator of message framing effects on smoking cessation success. METHODS: Dependence scores were dichotomized into high and low dependence (n = 249). RESULTS: Among high-dependent smokers, gain-framed messages were associated with higher levels of smoking abstinence both during and post-treatment than loss-framed messages. There was no differential effect of gain- versus loss-framed messages among low-dependent smokers. CONCLUSION: These preliminary findings suggest that the effectiveness of message framing interventions for treatment-seeking smokers may vary by smokers' level of nicotine dependence.

The identification of framed messages in the New York State Smokers' Quitline materials.

Research suggests that smoking cessation messages are most persuasive when framed in terms of the benefits achieved from quitting (i.e. gain-framed) than when framed in terms of the costs of not quitting (i.e. loss-framed). It is unknown, however, if these findings about optimal message frames have been translated into public health practice. The current study examined message framing in telephone counseling sessions with smokers calling the New York State Smokers' Quitline (NYSSQ). We conducted a content analysis of all NYSSQ print material and 12 Quitline service calls. Two independent raters coded each message within these documents as being gain-framed, loss-framed or non-framed. Messages from the service calls also were coded for their function (e.g. information provision, information gathering). Interrater reliability was acceptable (kappa > 0.80). Of the 997 print messages evaluated, 21.6% were gain-framed, 13.8% were loss-framed and 64.6% were non-framed. For the service calls, only the messages with an information provision function included framed content. Of the 420 information provision messages, 10.2% were gain-framed, 1.7% were loss-framed and 88.1% were non-framed. The loss-framed and non-framed messages indicate missed opportunities for providing gain-framed messages within the Quitline services, thus emphasizing a possible gap between research and practice.

Tailoring messages to individual differences in monitoring-blunting styles to increase fruit and vegetable intake.

OBJECTIVE: To examine whether messages matched to individuals' monitoring-blunting coping styles (MBCS) are more effective in increasing fruit and vegetable intake than mismatched messages. MBCS refers to the tendency to either attend to and amplify, or distract oneself from and minimize threatening information. DESIGN/SETTING: Randomly assigned messages were tailored to resonate with either monitors or blunters and delivered at baseline, 1 week, 2 months, and 3 months later. Surveys were conducted at baseline and 2 and 4 months later. PARTICIPANTS: 531 callers to a cancer information hotline who did not meet the 5 A Day guideline. INTERVENTION: A brief telephone-delivered message and 3 mailings of booklets and promotional items encouraging fruit and vegetable intake, tailored for either monitors or blunters. MAIN OUTCOME MEASURE: Fruit and vegetable intake 2 and 4 months post-baseline. ANALYSIS: Hierarchical regression modeling. RESULTS: Messages matched to MBCS were more effective than mismatched messages, particularly for the monitor message, in increasing intake at 2 months but not at 4 months. CONCLUSIONS AND IMPLICATIONS: These minimal interventions influenced fruit and vegetable intake. MBCS may be a promising target for developing tailored messages aimed at increasing intake, although additional research is needed to verify the robustness of these findings.

Greater daily leisure time physical activity is associated with lower chronic disease risk in adults with spinal cord injury.

The objective of this study was to examine the relationship between leisure time physical activity (LTPA) and common risk factors for cardiovascular disease (CVD) and type 2 diabetes in community-dwelling adults with chronic spinal cord injury (SCI). LTPA was measured using the Physical Activity Recall Assessment for People with SCI in 76 men and women with chronic (> or =1 year) paraplegia or tetraplegia, living in or near Hamilton, Ontario. Body mass index (BMI), waist circumference, body composition (fat mass (FM) and fat-free mass (FFM)), blood pressure, and biochemical data were collected. Thirty-seven percent (n = 28 participants) were inactive, reporting no LTPA whatsoever, and were compared with an equal-sized group consisting of the most active study participants (> or =25 min of LTPA per day). After adjusting for significant covariates, BMI (18.7%), %FM (19.4%), and C-reactive protein (143%) were all lower, and %FFM was higher (7.2%), in active participants (all p < or = 0.05). Ten percent of active participants vs. 33% of inactive participants were insulin resistant (p = 0.03). Waist circumference (17.6%) and systolic blood pressure (15.3%) were lower in active vs. inactive participants with paraplegia (both p < or = 0.05), but not tetraplegia. In conclusion, greater daily LTPA is associated with lower levels of selected CVD and type 2 diabetes risk factors in individuals living with SCI. Whether this relationship translates into a lower incidence of these chronic diseases has yet to be determined.

Promoting fruit and vegetable intake through messages tailored to individual differences in regulatory focus.

BACKGROUND: Researchers must identify strategies to optimize the persuasiveness of messages used in public education campaigns encouraging fruit and vegetable (FV) intake. PURPOSE: This study examined whether tailoring messages to individuals' regulatory focus (RF), the tendency to be motivated by promotion versus prevention goals, increased the persuasiveness of messages encouraging greater FV intake. METHOD: Participants (n = 518) completed an assessment of their RF and were randomly assigned to receive either prevention- or promotion-oriented messages. Messages were mailed 1 week, 2 months, and 3 months after the baseline interview. Follow-up assessments were conducted 1 and 4 months after the baseline assessment. RESULTS: Regression analyses revealed that at Month 4, the messages were somewhat more efficacious when congruent with participants' RF. CONCLUSION: RF may be a promising target for developing tailored messages promoting increased FV intake, and particularly for encouraging individuals to meet FV guidelines.

Promoting participation in physical activity using framed messages: an application of prospect theory.

OBJECTIVES: Messages designed to motivate participation in physical activity usually emphasize the benefits of physical activity (gain-framed) as well as the costs of inactivity (loss-framed). The framing implications of prospect theory suggest that the effectiveness of these messages could be enhanced by providing gain-framed information only. We compared the effectiveness of gain-, loss-, and mixed-framed messages for promoting moderate to vigorous physical activity. DESIGN: Randomized trial. METHOD: Sedentary, healthy callers to the US National Cancer Institute's Cancer Information Service (N=322) received gain-, loss-, or mixed-framed messages on three occasions (baseline, Week 1, and Week 5). Social cognitive variables and self-reported physical activity were assessed at baseline, Week 2, and Week 9. Separate regression analyses were conducted to examine message effects at each assessment point. RESULTS: At Week 2, gain- and mixed-framed messages resulted in stronger intentions and greater self-efficacy than loss-framed messages. At Week 9, gain-framed messages resulted in greater physical activity participation than loss- or mixed-framed messages. Social cognitive variables at Week 2 did not mediate the Week 9 framing effects on physical activity participation. CONCLUSIONS: Using gain-framed messages exclusively may be a means of increasing the efficacy of physical activity materials.

[Physical activity guidelines for Canadians: strategies for dissemination of the message, expectations for change and evaluation]. / Guides d'activité physique pour les Canadiens : stratégies de diffusion des messages, attentes réalistes pour le changement et évaluation.

Physical activity guidelines offer evidence-based behavioural benchmarks that relate to reduced risk of morbidity and mortality if people adhere to them. Essentially, the guidelines tell people what to do, but not why and how they should do it. Thus, to motivate adherence, messages that translate guidelines should convey not only how much physical activity one should attempt and why it is recommended, but also how to achieve such a recommendation. Canada's physical activity guides exemplify how guidelines can be translated. This paper (i) provides a brief overview of the challenges encountered in creating the existing guides and (ii) highlights important practical issues and empirical evidence that should be considered in the future when translating guidelines into messages and disseminating these messages. We draw on the successes of past efforts to translate the goals of physical activity guidelines and on recent literature on messages and media campaigns to make recommendations. Information to motivate people to move toward the goals in physical activity guidelines should be translated into a set of messages that are informative, thought provoking, and persuasive. These messages should be disseminated to the public via a multi-phase social-marketing campaign that is carefully planned and thoroughly evaluated.

[Guides and guidelines for physical activity for Canadians: facts and future]. / Lignes directrices et guides sur l'activité physique à l'intention des Canadiens : les faits et l'avenir.

This article summarizes the main findings from the papers included in this journal supplement. It consolidates the evidence currently available to inform and advance the development of physical activity guidelines for Canadians, and it highlights the specific needs of various population subgroups. The challenges of translating guideline information into effective and persuasive physical activity messages, of campaigns to disseminate messages and of related evaluations are underlined. Recommendations on how to proceed are based on the evidence base provided by this series of papers; the immediate next steps mandated by this initiative are outlined and priorities for future research are indicated.

Motivating cancer prevention and early detection behaviors using psychologically tailored messages.

Tailoring health messages to make them salient to recipients is a strategy to motivate cancer prevention and early detection behaviors. Various tactics can be used to tailor health materials; our approach involves tailoring messages to individual differences in the psychological processes by which people understand health information. To summarize our tailoring approach, we review findings from six field experiments (four published, two pending publication) conducted in collaboration with the National Cancer Institute's (NCI's) Cancer Information Service (CIS) examining the utility of psychologically tailored messages. Messages were tailored to individual variability in the following: (a) need for cognition, (b) monitor/blunting coping style, (c) health locus of control, and (d) regulatory focus. Collectively, the findings suggest that, as hypothesized, messages congruent with the recipients' psychological style of health information processing (i.e., matched messages) are more persuasive in promoting screening mammography and fruit and vegetable consumption than mismatched messages. This line of research provides evidence for the utility of psychological tailoring as a health communication strategy and direction for developing effective health messages in a variety of settings.