Innovative video tailoring for dietary change: final results of the Good for you! cluster randomized trial.

BACKGROUND: Effective, low-cost approaches are needed to enhance dietary behavior change. While both video and tailoring technology have been effective interventions to improve diet, these approaches have never been combined to study the effectiveness of tailored videos. The purpose of this paper is to discuss the results of Good For You!, a randomized trial that tested the efficacy of innovative, individually tailored videos in helping worksite employees decrease dietary fat and increase fruit and vegetable (F&V) intake. METHODS: Worksites were matched on approximate size, type of company and workforce composition and randomized to one of three experimental conditions: Non-Tailored written information (NT) (n = 14), Tailored Written information (TW) (n = 14), or Tailored Written + Tailored Video (TW + TV) (n = 15). Evaluation was conducted at baseline, 4 and 7 months. We used the NCI Fat Screener and an adapted Food Habits Questionnaire (FHQ) to estimate fat intake and fat-related behaviors, the NCI F&V Screener and F&V Habits Questionnaire (FVHQ) to measure F&V intake and behaviors. Generalized linear models were examined for all outcome measurements. RESULTS: 2525 worksite employees were recruited. At 4 months, dietary fat intake decreased significantly more for TW (-2.95 %) and TW + TV (-3.14%) compared with NT (-2.42%). FHQ scores decreased significantly more for TW + TV than the other two groups. Fruit intake increased the most for TW + TV compared to NT and TW. Both TW (1.30 cups) and TW + TV (1.59 cups) increased F&V intake significantly more than NT (0.78 cups). TW + TV showed the largest increase in F&V behaviors on the FVFQ. At 8 months, dietary fat change continued to be significantly better for TW + TV (-3.48%) than NT (3.01%). F&V intake increased significantly more for the TW + TV group (1.38 cups) compared to the NT group (1.04 cups) and FVHQ changes were significantly greater in TW + TV and TW than for NT. CONCLUSIONS: The tailored intervention participants were more likely to decrease fat and increase F&V intake. The TW + TV group was generally the stronger of the two tailored interventions, especially at the longer term follow-up, demonstrating the promise of tailored video as an intervention to change eating habits. Future studies should explore newer channels and technologies in addition to DVDs for delivering tailored video interventions such as the internet and smart phones. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00301678.

How is food insecurity associated with dietary behaviors? An analysis with low-income, ethnically diverse participants in a nutrition intervention study.

Food insecurity has been associated with lower nutrient intake as well as lower intake of fruits and vegetables. However, little is known about the association of food insecurity and dietary behaviors, including food choices and preparation methods. This study examines the relationship between food insecurity and dietary behaviors of low-income adults (N = 1,874; 55% Hispanic) who completed the baseline telephone survey for a nutrition education study. From April 2003 to August 2004, data were collected on demographics and food-security status and validated dietary measures: fruit and vegetable screener and Food Habits Questionnaire were used to assess fat-related behaviors (food choices or preparation methods that lead to an increase or decrease in fat intake). χ² tests were conducted to compare each demographic variable by food-security status. Univariate linear regression models examined dietary variables by food-security status in univariate models initially, then in multivariable models adjusting for demographics. Half of participants reported food insecurity. Food Habits Questionnaire scores were significantly greater in the food-insecure group, reflecting a higher fat intake (P < 0.05). Fruit (with juice) intake was significantly greater in the food-insecure participants reflecting increased juice intake (P < 0.05). Food-insecure individuals reported a higher juice intake and a lower frequency of fat-lowering behaviors. Future interventions with food-insecure individuals should include nutrition education as well as efforts to increase access and availability to healthier foods. Further qualitative and quantitative research is needed on the relationship between diet and food insecurity.

Effectiveness of different methods for delivering tailored nutrition education to low income, ethnically diverse adults.

BACKGROUND: Computer-tailored written nutrition interventions have been shown to be more effective than non-tailored materials in changing diet, but continued research is needed. Your Healthy Life/Su Vida Saludable (YHL-SVS) was an intervention study with low income, ethnically diverse, English and Spanish-speaking participants to determine which methods of delivering tailored written nutrition materials were most effective in lowering fat and increasing fruit and vegetable (F&V) intake. METHODS: YHL-SVS was a randomized controlled trial with four experimental conditions: 1) Nontailored (NT) comparison group; 2) Single Tailored (ST) packet; 3) Multiple Tailored (MT) packet mailed in four installments; 4) Multiple Re-Tailored (MRT) MT packets re-tailored between mailings via brief phone surveys. A baseline telephone survey collected information for tailoring as well as evaluation. Follow-up evaluation surveys were collected 4- and 7-months later. Primary outcomes included F&V intake and fat related behaviors. Descriptive statistics, paired t-test and ANOVA were used to examine the effectiveness of different methods of delivering tailored nutrition information. RESULTS: Both the ST and MT groups reported significantly higher F&V intake at 4-months than the NT and MRT groups. At 7 months, only the MT group still had significantly higher F&V intake compared to the NT group. For changes in fat-related behaviors, both the MT and MRT groups showed more change than NT at 4 months, but at 7 months, while these differences persisted, they were no longer statistically significant. There was a significant interaction of experimental group by education for change in F&V intake (P = .0085) with the lowest educational group demonstrating the most change. CONCLUSION: In this study, tailored interventions were more effective than non-tailored interventions in improving the short-term dietary behaviors of low income, ethnically diverse participants. Delivery of information in multiple smaller doses over time appeared to improve effectiveness. Future studies should determine which variables are mediators of dietary change and whether these differ by participant demographics. Moreover, future research should differentiate the effects of tailoring vs. cultural adaptation in ethnically diverse populations and study the dissemination of tailored interventions into community-based settings. TRIAL REGISTRATION: Current Controlled Trials # NCT00301691.

Dietary behaviors and portion sizes of black women who enrolled in SisterTalk and variation by demographic characteristics.

OBJECTIVE: To describe the dietary behaviors of black women who enrolled in the SisterTalk weight control study. DESIGN: Baseline data collected via telephone survey and in-person screening. SETTING: Boston, Massachusetts and surrounding areas. PARTICIPANTS: 461 black women completed the baseline assessments. MAIN OUTCOME MEASURES: Measured height and weight; self-reported demographics, risk factors, and dietary variables including fat-related eating behaviors, food portion size, and fruit, vegetable, and beverage intake. ANALYSIS: Analysis of variance (ANOVA) models with food habits questionnaire (FHQ) scores as the dependent variable and demographic categories as the independent variables; ANOVA models with individual FHQ item scores as the dependent variable and ethnic identification as the independent variable. RESULTS: More than 60% reported eating < 5 servings of fruits and vegetables/day. Self-reported portion sizes were large for most food items. Older age, being born outside the United States, living without children, and being retired were significantly associated with a higher prevalence of fat-lowering behaviors. The frequency of specific fat-lowering behaviors and portion size also differed by ethnic identification. CONCLUSIONS AND IMPLICATIONS: The findings support the need for culturally appropriate interventions to improve the dietary intake of black Americans. Further studies should examine the dietary habits, food preparation methods, and portion sizes of diverse groups of black women.

Feasibility, cost, and cost-effectiveness of a telephone-based motivational intervention for underserved pregnant smokers.

This study reports on the evaluation of the feasibility, cost, and cost-effectiveness of a proactively provided telephone-based motivational smoking cessation intervention to an underserved population of pregnant smokers who may or may not receive ongoing prenatal care. As part of the New England SCRIPT randomized clinical trial comparing the efficacy of three types of smoking cessation interventions for pregnant smokers, one-third of the women (n = 358) received a motivational telephone counseling intervention (MI) delivered by trained counselors using a semistructured protocol. Although this population was very mobile, the MI counselors were able to reach 86% of the women with at least one call and 46% received all three calls. The group receiving three MI calls had a cotinine-confirmed quit rate of 23%. Cost-effectiveness analyses for those women receiving telephone counseling supported the net benefit in favor of the three phone calls compared with the women who did not receive any telephone calls, with an effectiveness to cost ratio of 1:US dollars 84. Our results suggest that telephone-based motivational smoking cessation counseling may be a feasible and cost-effective method for low-income pregnant smokers enrolled in prenatal care.

Development and evaluation of the nutrition component of the Rapid Eating and Activity Assessment for Patients (REAP): a new tool for primary care providers.

OBJECTIVES: 1. To describe the development of a dietary assessment tool (Rapid Eating and Activity Assessment for Patients [REAP]) that quickly assesses a patient's diet and physical activity and facilitates brief counselling by a primary care provider, and 2. To describe the evaluation of the REAP in terms of its reliability, validity, and ease of use by primary care providers. DESIGN, SETTING AND PARTICIPANTS: The evaluation of REAP included: 1) an implementation feasibility study conducted with 61 medical students and practicing physicians in practice settings at various medical schools; 2) a calibration study with 44 Brown University Medical School students; 3) cognitive assessment testing with 31 consumers in Rhode Island; and 4) a reliability and calibration study of the revised tool with 94 consumers in Rhode Island and Massachusetts. RESULTS: The feasibility study revealed moderately high rankings on usefulness, ease, practicality, and helpfulness. The calibration studies demonstrated that REAP has excellent test-retest reliability (r = 0.86, P < .0001), is correlated with the Healthy Eating Index score (r = 0.49, P = .0007), and is significantly associated with intake of most nutrients studied. CONCLUSIONS AND IMPLICATIONS: REAP has adequate reliability and validity to be used in primary care practices for nutrition assessment and counselling, and is also user-friendly for providers.

Using qualitative and quantitative formative research to develop tailored nutrition intervention materials for a diverse low-income audience.

More effective nutrition education to reach low-income and ethnic minority populations is needed. As part of a project to develop a tailored nutrition education intervention to meet the needs of low-income Hispanics and non-Hispanics, complementary, mixed methods of formative research were used to determine specific characteristics of the target population. The aim was to ensure that the full array of nutrition messages would be comprehensive enough to effectively tailor to the level of the individual. Barriers to healthy eating were delineated for three main dietary behaviors (number of items delineated in parentheses): lowering fat (11), increasing fruit (8) and increasing vegetables (6). Information was also collected regarding motivators for healthy eating (5), situational barriers to making healthy choices (4), other nutrition-related interests (8) and typical eating habits and food-related choices of the target audience.

The development of SisterTalk: a cable TV-delivered weight control program for black women.

Overweight and obesity have reached epidemic proportions in the United States, with black women disproportionately affected. SisterTalk is a weight control program designed specifically for delivery to black women via cable TV. The theoretical and conceptual frameworks and formative research that guided the development and cultural tailoring of SisterTalk are described. Social Action Theory was applied in the development of SisterTalk along with a detailed behavioral analysis of the way that black women view weight and weight loss within the context of their cultural and social realities. The entire intervention development process was framed using this information, rather than by changing only superficial aspects of program delivery. Community networking and both qualitative and quantitative interview techniques from the fields of social marketing and cultural anthropology were used to involve black women from Boston in the design and implementation of a program that would be practical, appealing, and culturally sensitive. Also discussed are strategies for evaluating the program, and lessons learned that might have broader applicability are highlighted. The development of the SisterTalk program could provide a useful starting point for development of successful weight control programs for black women in other parts of the United States as well as for other ethnic and racial groups.