Can a health warning label diminish the persuasive effects of health-oriented nutrition advertising on ready-to-drink alcohol product packaging? A randomized experiment.

BACKGROUND AND AIMS: A health warning label (HWL) cautioning about the link between alcohol and cancer may be able to communicate alcohol risks to consumers and potentially counter health-oriented nutrition advertising on ready-to-drink alcoholic beverages. This study aimed to examine the independent and combined effects of nutrient content claims (e.g. 0 g sugar) and a HWL on perceived product characteristics and intentions to consume, and whether these effects differed by gender and age. DESIGN: A between-subjects randomized experiment. Participants were randomized to view one of six experimental label conditions: nutrient content claims plus nutrition declaration (NCC + ND), ND only, NCC + ND + HWL, ND + HWL, HWL only and no NCC, ND or HWL, all on a ready-to-drink (RTD) vodka-based soda container. SETTING AND PARTICIPANTS: Alcohol consumers (n = 5063; 52% women) in Canada aged 18-64 recruited through a national online panel. MEASUREMENTS: Participants completed ratings of perceived product characteristics, perceived product health risks, and intentions to try, buy, binge and drink the product. FINDINGS: Compared with the reference condition NCC + ND (current policy scenario in Canada), the other five experimental label conditions were associated with lower ratings for perceiving the product as healthy. All experimental conditions with a HWL were associated with lower product appeal, higher risk perceptions and reduced intentions to try, buy and binge. The experimental condition with a HWL only was associated with intentions to consume fewer cans in the next 7 days (ß = -0.72, 95% confidence interval [CI] = -1.37,-0.08) versus the reference. Few interactions were observed, suggesting that label effects on outcomes were similar by gender and age. CONCLUSIONS: Health warning labels on alcohol packaging appear to be associated with lower product appeal, higher perceived health risks and reduced consumption intentions, even in the presence of nutrient content claims.

Development and initial validation of the perceived instrumental effects of violence in sport scale.

Introduction: A growing body of research is looking into risk factors for interpersonal violence (IV) in sport. This research suggests the existence of several important risk factors, especially organizational and social factors. One of these factors is the beliefs regarding instrumental effects of violence. Coaches may want to drive performance, deter failure, test resilience and commitment, develop toughness, assure interpersonal control, and promote internal competition. In sum, available evidence suggests the risk of IV increases when coaches believe in the effectiveness of strategies involving IV to enhance athlete performance or perceive external approval for these practices. Methods: The studies presented in this article seeks to develop and validate the Perceived Instrumental Effects of Violence in Sport (PIEVS) Scale in order to measure those beliefs in coaches. In study 1, item generation, expert consultation, cognitive interviews, pilot test and item reduction phases led to 25 items for the PIEVS around six dimensions. In study 2, exploratory factor analysis (EFA) was conducted with 690 coaches in order to determine the PIEVS factorial structure and the convergent and divergent validity of the scale was tested (long and short form). Results: Our results suggested a one-factor solution for the PIEVS (25 items). This one-factor model provided an excellent fit to the data and a very good internal consistency. The PIEVS and empowering motivational climate were negatively correlated, which supported divergent validity as expected. The PIEVS was positively correlated with the disempowering motivational climate and with sport ethic norms, which supported convergent validity as expected. Discussion: These findings provide preliminary evidence for the appropriateness of the PIEVS Scale to measure perceived instrumental effects of violence in coaches.

Social determinants of long-term reported changes in physical activity and healthy eating during the COVID-19 pandemic in Canada: multiple cross-sectional surveys analysis from the iCARE study.

The long-term consequences of COVID-19 on healthy behaviours (physical activity practice and healthy eating) among Canadians remain largely unexplored. The objectives were (i) to describe the proportion of Canadians who reported a change in healthy behaviours, 9 and 20 months since the beginning of COVID-19; and (ii) to identify the social determinants associated with healthy behaviour changes. Using two representative Canadian surveys from the International COVID-19 Awareness and Responses Evaluation study (January 2021, n = 3000; November 2021, n = 3002), reported changes in healthy behaviours were assessed as follows: "In general, how have the following behaviours changed since the start of COVID-19?": (1) Increase; (2) No change; and (3) Decrease. The association between individual determinants and changes in healthy behaviours was analyzed using weighted univariate polytomous logistic regression models. In January 2021, 41% and 22% of respondents reported a decline in physical activity and healthy eating, respectively, while in November 2021, 34% and 20% of respondents reported a decline in physical activity and healthy eating, respectively. The main determinants associated with changes in healthy behaviours were younger age (18-25 years), area of residency, student status, changes in bodyweight, financial concerns/insecurity, anxiety/depression, and ethnicity. Changes in healthy behaviours were also associated with household composition, presence of chronic diseases, and occupation. In sum, this study depicted long-term changes in healthy behaviours during COVID-19, with differential changes according to social determinants of health. This study highlighted the presence of health inequalities in Canada during COVID-19 and supports the implementation of personalized programs in prevention of healthy behaviour degradation.

Examining public health practitioners' perceptions and use of behavioural sciences to design health promotion interventions.

BACKGROUND: Behavioural sciences have been shown to support the development of more effective interventions aimed at promoting healthy lifestyles. However, the operationalization of this knowledge seems to be sub-optimal in public health. Effective knowledge transfer strategies are thus needed to optimize the use of knowledge from behavioural sciences in this field. To this end, the present study examined public health practitioners' perceptions and use of theories and frameworks from behavioural sciences to design health promotion interventions. METHODS: This study adopted an exploratory qualitative design. Semi-structured interviews were conducted among 27 public health practitioners from across Canada to explore current intervention development processes, the extent to which they integrate theory and framework from behavioural sciences, and their perceptions regarding the use of this knowledge to inform intervention design. Practitioners from the public sector or non-profit/private organizations who were involved in the development of interventions aimed at promoting physical activity, healthy eating, or other healthy lifestyle habits (e.g., not smoking) were eligible to participate. RESULTS: Public health practitioners generally agreed that behaviour change is an important goal of public health interventions. On the other hand, behavioural science theories and frameworks did not appear to be fully integrated in the design of public health interventions. The main reasons were (1) a perceived lack of fit with current professional roles and tasks; (2) a greater reliance on experiential-produced knowledge rather than academic knowledge (mainly for tailoring interventions to local setting characteristics); (3) the presence of a fragmented knowledge base; (4) the belief that theories and frameworks require too much time and resources to be operationalized; and 4) the belief that using behavioural sciences might undermine partnership building. CONCLUSIONS: This study provided valuable insights that may inform knowledge transfer strategies that could be optimally designed to support the integration of behavioural sciences theories and frameworks into public health practices.

Nutrition cues on ready-to-drink alcoholic beverage containers sold in grocery stores in Québec City, Canada.

Nutrition cues on ready-to-drink alcoholic beverages (RTDs) may create an illusion of healthfulness; however, nutrition information on alcohol in Canada is seldom regulated. This research aimed to systematically record the use of nutrition cues on a subsample of RTDs sold in grocery stores. In July 2021, all available RTDs were purchased from three major grocery store banners in Québec City, Canada. Data regarding container size, purchase format, alcohol-by-volume (ABV), presence of nutrition cues (nutrient claims, other food-related claims and nutrition facts tables [NFTs]) and container surface occupied by nutrition cues were recorded. RTDs were classified as hard seltzers or pre-mixed cocktails and their ABV as "light-strength" (3.5%-4.0% ABV) and "regular-strength" (>4.0%-7.0% ABV). In total (n = 193), 23% were hard seltzers and 17% light-strength. Most RTDs (68%) had ≥1 type of nutrition cue, most often natural flavour claims (45%), an NFT (38%), and calorie claims (29%). Light-strength beverages were more likely than regular-strength to carry any nutrient claim (97% vs. 19%, p < 0.0001), an NFT (97% vs. 26%, p < 0.0001) and other food-related claims (e.g., natural flavour) (88% vs. 52%, p = 0.0002). In adjusted regression analyses, hard seltzers were more likely than pre-mixed cocktails to carry any nutrient claim (AOR = 19.1, 95% CI:7.5,48.7), any other food-related claim (AOR = 7.5, 95% CI:2.9,19.4), and an NFT (AOR = 45.5, 95% CI:12.6,163.9). The mean container surface occupied by nutrition cues was higher for hard seltzers compared to pre-mixed cocktails (13% vs 3%, p < 0.0001). The high proportion of RTDs carrying nutrition cues supports the need to further regulate labelling and marketing of RTDs.

Promoting healthy eating in early pregnancy in individuals at risk of gestational diabetes mellitus: does it improve glucose homeostasis? A study protocol for a randomized control trial.

Background: Healthy eating during pregnancy has favorable effects on glycemic control and is associated with a lower risk of gestational diabetes mellitus (GDM). According to Diabetes Canada, there is a need for an effective and acceptable intervention that could improve glucose homeostasis and support pregnant individuals at risk for GDM. Aims: This unicentric randomized controlled trial (RCT) aims to evaluate the effects of a nutritional intervention initiated early in pregnancy, on glucose homeostasis in 150 pregnant individuals at risk for GDM, compared to usual care. Methods: Population: 150 pregnant individuals ≥18 years old, at ≤14 weeks of pregnancy, and presenting ≥1 risk factor for GDM according to Diabetes Canada guidelines. Intervention: The nutritional intervention initiated in the first trimester is based on the health behavior change theory during pregnancy and on Canada's Food Guide recommendations. It includes (1) four individual counseling sessions with a registered dietitian using motivational interviewing (12, 18, 24, and 30 weeks), with post-interview phone call follow-ups, aiming to develop and achieve S.M.A.R.T. nutritional objectives (specific, measurable, attainable, relevant, and time-bound); (2) 10 informative video clips on healthy eating during pregnancy developed by our team and based on national guidelines, and (3) a virtual support community via a Facebook group. Control: Usual prenatal care. Protocol: This RCT includes three on-site visits (10-14, 24-26, and 34-36 weeks) during which a 2-h oral glucose tolerance test is done and blood samples are taken. At each trimester and 3 months postpartum, participants complete web-based questionnaires, including three validated 24-h dietary recalls to assess their diet quality using the Healthy Eating Food Index 2019. Primary outcome: Difference in the change in fasting blood glucose (from the first to the third trimester) between groups. This study has been approved by the Ethics Committee of the Centre de recherche du CHU de Québec-Université Laval. Discussion: This RCT will determine whether a nutritional intervention initiated early in pregnancy can improve glucose homeostasis in individuals at risk for GDM and inform Canadian stakeholders on improving care trajectories and policies for pregnant individuals at risk for GDM. Clinical trial registration: https://clinicaltrials.gov/study/NCT05299502, NCT05299502.

Development and validation of a questionnaire assessing eating pleasure dimensions in the adult French-speaking population of the province of Québec, Canada.

The purpose of this study was to develop and validate a questionnaire assessing eating pleasure dimensions in the adult French-speaking population of the province of Québec, Canada. We developed the Eating Pleasure Questionnaire, a 53-item questionnaire. An expert panel evaluated the content validity, and a pre-test was performed with 30 French-speaking Quebecers (15 men and 15 women, mean age = 46 years) to evaluate the face validity. A sample of 300 Quebecers (150 men and 150 women, mean age = 36 years) completed the online questionnaire for validation. The structure of the questionnaire was examined using exploratory factor analysis (EFA). Internal consistency was evaluated with Cronbach's alpha coefficients. Test-retest reliability was assessed using intra class correlation coefficients (ICC) and construct validity, using Pearson's correlations. Evaluation of content validity and face validity led to the clarification of the instructions, the suppression of two items, the addition of two items and some reformulations. The EFA showed a 7-factor structure: 1- health/ideological food choice motives, 2- sensory experiences and individual preferences, 3- social experiences, 4- mindful eating, 5- emotional/situational eating and reward, 6- food preparation process and 7- new experiences. Cronbach's alpha values for the seven factors ranged from 0.67 to 0.86. The total scale Cronbach's alpha was 0.91, which suggests a good internal consistency. The questionnaire appears reliable with ICC ranging from 0.66 to 0.87. It also showed a good construct validity, with expected positive associations with food well-being (how people link food to well-being), intrinsic motivation, and the pleasure orientation (the importance of obtaining pleasure from food). Overall, these analyses suggest that the Eating Pleasure Questionnaire is valid to evaluate eating pleasure dimensions in our population.

Changes in diet quality and food security among adults during the COVID-19-related early lockdown: results from NutriQuébec.

BACKGROUND: The impact that the coronavirus disease 2019 (COVID-19)-related early lockdown has had on dietary habits of the population and on food insecurity is unknown. OBJECTIVE: The aim of this study was to document the change in diet quality and in food insecurity observed during the COVID-19-related early lockdown. We hypothesized that the lockdown was associated with a deterioration in overall diet quality and an increase in food insecurity. METHODS: Data are from a COVID-19 subsample of NutriQuébec, a web-based cohort destined to study temporal changes in dietary habits among adults in Quebec, Canada. Participants completed questionnaires before (between June 2019 and February 2020) and during (April to May 2020) early lockdown, including a validated web-based 24-h recall (n = 853) and a questionnaire on food security (n = 922). Primary study outcomes were temporal changes in diet quality measured by the Healthy Eating Index (HEI)-2015 and in the prevalence of food insecurity. RESULTS: There was a small increase in the HEI-2015 during the COVID-19 early lockdown compared with baseline (+1.1 points; 95% CI: 0.6, 1.5), mostly due to small improvements in the intakes of whole grains, greens and beans, refined grains, total vegetables, total dairy, seafood and plant proteins, added sugar, and total protein subscores of the HEI-2015. Exploratory analyses suggested that individuals aged 18-29 y (+3.6 points; 95% CI: 2.4, 4.7), participants with lower education (+1.9 points; 95% CI: 1.3, 2.6), or with obesity (+3.8 points; 95% CI: 2.7, 4.8) showed particularly important increases in the HEI-2015. The prevalence of food insecurity was reduced from 3.8% at baseline to 1.0% during the early lockdown (prevalence ratio = 0.27; 95% CI: 0.08, 0.94). CONCLUSIONS: Contrary to our hypotheses, diet quality has slightly improved and prevalence of food insecurity was reduced in this sample of adults from Quebec during the COVID-19-related early lockdown. These results may be generalizable only to relatively healthy populations.

On successfully avoiding communication inequalities and instilling positive impacts: The experience of the 2012-2016 WIXX campaign in Québec.

Communication campaigns can contribute to promoting physical activity (PA) among children. However, health inequalities can ensue from this type of public health intervention. Using a pre-test posttest design, we examined the effects of social disadvantage on the large-scale WIXX communication campaign and whether or not social disadvantage moderated WIXX's impact on PA. Parents of youths were identified using random digit dialing procedures and asked permission for their child to participate in a telephone survey. Surveys were conducted each year between 2012 and 2016. Moderating effects of individual-level and area-based indicators of social disadvantage on campaign effectiveness were examined. Self-reported levels of PA and trying new PAs were the outcomes. Exposure was defined as a function of ads recall and brand awareness. Logistic regression analyses controlling for survey periods, screen time, language, school grade, and attitudes toward PA were performed in 2020. Among girls, no significant interaction effects were observed for household income, parental education, and material deprivation. A significant interaction effect was observed for minority group status on PA (OR = 2.4; 95%CIs: 1.2, 4.9) and trying of new activities (OR = 2.5; 95%CIs: 1.2, 5.1). A significant interaction effect between social deprivation and exposure was observed for trying new activities among girls (OR = 1.8; 95%CIs: 1.0, 3.2). Among boys, no significant interaction effects were observed for any indicators. Results suggest no clear evidence of communication inequalities as a result of the WIXX campaign but reveal positive impacts of the campaign among more socially disadvantaged girls.

NutriQuébec: a unique web-based prospective cohort study to monitor the population's eating and other lifestyle behaviours in the province of Québec.

INTRODUCTION: The epidemic of non-communicable diseases including cardiovascular diseases and type 2 diabetes is attributable in large part to unhealthy eating and physical inactivity. In the fall of 2016, the Québec government launched its first-ever Government Health Prevention Policy (Politique gouvernementale de prévention en santé (PGPS)) to influence factors that lead to improved health status and quality of life as well as reduced social inequalities in health in the population of Québec. NutriQuébec is a web-based prospective open cohort study whose primary aim is to provide essential data for the evaluation of the PGPS on the Québec population's eating and other lifestyle behaviours over time. METHODS AND ANALYSIS: Over a first phase of 3 years, NutriQuébec will enrol 20 000 adults living in the province of Québec in Canada through a multimedia campaign designed to reach different segments of the population, including subgroups with lower socioeconomic status. Participants will be invited to complete on a web platform nine core questionnaires on a yearly basis. Questionnaires will assess several dimensions related to lifestyle, including eating and physical activity behaviours, as well as a large number of personal characteristics and global health status. Temporal trends in eating and lifestyle behaviours will be analysed in relation to the implementation of the PGPS to provide essential data for its evaluation at a population level. Data analyses will use sociodemographic weights to adjust responses of participants to achieve, so far as is possible, representativeness of the adult Québec population. ETHICS AND DISSEMINATION: Université Laval Research Ethics Board approved the NutriQuébec project. Data analysis, presentations in conferences and publication of manuscripts are scheduled to start in 2020. TRIAL REGISTRATION NUMBER: NCT04140071.

A cross-sectional survey examining motivation and beliefs to participating in a web-based prospective cohort study on nutrition and health among individuals with a low socioeconomic status.

BACKGROUND: Prospective cohort studies may support public health efforts in reducing health inequalities. However, individuals with a low socioeconomic status (SES) are generally underrepresented in health research. This study aimed to examine the intention and determinants of intention of individuals with a low SES towards participation in a Web-based prospective project on nutrition and health (NutriQuébec) in order to develop recruitment and retention strategies. METHODS: A cross-sectional survey based on the Theory of planned behaviour was conducted in the Province of Québec, Canada. Low SES individuals (high school or less and annual household income < $55,000 CAN) were recruited through a Web panel of a polling firm to assess intention, attitude, subjective norm and perceived behavioural control (PBC) towards participation in the NutriQuébec project. Linear regression and logistic regression analyses were conducted. RESULTS: Mean age of respondents (184 women, 141 men) was 57.6 y (SD = 13.6). Attitude (ß = 0.54, 95%CI: 0.41-0.68) and PBC (ß = 0.50, 95%CI: 0.37-0.63) were significantly associated with intention. Participants who agreed that participating in the study would contribute to an improvement in 1) collective health (odds ratio [OR] = 2.15, 95%CI: 1.27-3.64) and in 2) one's lifestyle habits (OR = 1.70, 95%CI: 1.04-2.78) were more likely to express positive intention compared to participants who did not agree with these statements. Participants who agreed to participate in the study even 1) in the absence of a financial incentive (OR = 1.43, 95%CI: 1.04-1.99) and even 2) if the completion of questionnaires took up to two hours (OR = 1.78, 95%CI: 1.27-2.48) were also more likely to express high intention. Receiving a personalized brief health assessment (OR = 1.61, 95%CI: 1.13-2.30) and the use of simple questions in the questionnaires (OR = 1.54, 95%CI: 1.05-2.25) were facilitating factors associated with high intention. Participants believing that participation would be too time-consuming were less likely to have positive intention (OR = 0.57, 95%CI: 0.43-0.75). CONCLUSIONS: The development of a positive attitude and a high PBC towards participation in the NutriQuébec project will be necessary to obtain representative data of low SES adults.

Beliefs Related to Participation in a Large Web-Based Prospective Survey on Diet and Health Among Individuals With a Low Socioeconomic Status: Qualitative Study.

BACKGROUND: NutriQuébec is a Web-based prospective study on the relationship between diet and health as well as the impact of food-related health policies in the adult population of Québec, Canada. Recruitment and retention of individuals with a low socioeconomic status (SES) in such a study are known to be challenging, yet critical for achieving representativeness of the entire population. OBJECTIVE: This study aimed to identify the behavioral, normative, and control beliefs of individuals with a low SES regarding participation in the NutriQuébec project and to identify their preferences regarding recruitment methods. METHODS: A total of four focus groups were conducted in community centers located in low-income areas of Québec City, Canada. On the basis of the theory of planned behavior, participants' beliefs associated with attitude, subjective norm, and perceived behavioral control regarding hypothetical participation in the NutriQuébec project were identified. Focus groups were recorded, transcribed, and coded by two analysts. RESULTS: Participants (16 men and 12 women) were aged between 28 and 72 years, and a majority of the participants had an annual household income of Can $19,999 or less. The main perceived advantages of participating in the NutriQuébec project were contributing to improved collective health and supporting research. The only disadvantage identified was the risk of having to fill out too many questionnaires. Participants could not, in general, identify persons from their entourage who would approve or disapprove their participation in the study. The main facilitators identified were obtaining a brief health assessment and the ability to complete questionnaires in a way that is not Web-based. The main barrier was the lack of internet access. The preferred means of recruitment were through social media, television, and community centers. CONCLUSIONS: These results provide insightful information regarding the best methods and messages to use in order to recruit and retain individuals with a low SES in a population-based prospective study on lifestyle and health on the internet.

Pattern and correlates of public support for public health interventions to reduce the consumption of sugar-sweetened beverages.

OBJECTIVE: To examine the pattern and correlates of public support for twelve public health interventions aimed at reducing sugar-sweetened beverage (SSB) consumption. DESIGN: Cross-sectional population-based survey. Respondents were recruited using a random digit dialling procedure (landline telephone) and a random selection of telephone numbers (mobile telephone). Sampling quotas were applied for age, and the sample was stratified according to administrative regions. SETTING: The province of Québec, Canada. SUBJECTS: One thousand adults aged between 18 and 64 years and able to answer the survey questionnaire in French or English. RESULTS: Support was observed for a number of public health interventions, but the more intrusive approaches were less supported. Support for taxation as well as for sale and access restriction was positively associated with the perceived relevance of the government intervention, perceived effectiveness, and perceived associations between SSB consumption and chronic diseases. Believing that SSB consumption is a personal choice and daily consumption were generally negatively associated with strong support and positively associated with strong opposition. Sparse associations between sociodemographic and socio-economic characteristics were observed, with the exception of sex and age: women were generally more likely to support the examined public health strategies, while younger respondents were less likely to express support. CONCLUSIONS: Increasing perceived effectiveness and government responsibility for addressing the issue of SSB consumption could lead to increased support for SSB interventions. Increasing the belief that SSB consumption could be associated with chronic diseases would increase support, but SSB consumers and younger individuals are expected to be resistant.

Impact of pleasure-oriented messages on food choices: is it more effective than traditional health-oriented messages to promote healthy eating?

Some authors have suggested that eating pleasure is underused to promote healthy eating. However, little is known about the potential of pleasure-oriented messages to lead to healthier food choices. The aim of this study was to examine the effects of pleasure- and health-oriented messages on food choices made from a buffet. One hundred and ninety-eight participants (50% women), unaware of the real objective of the study, were randomized in three groups: 1) pleasure, 2) health, and 3) control. They first completed three 24 h food recalls to assess their overall diet quality using the Canadian Healthy Eating Index (C-HEI; score: 0 to 100). Thereafter, participants came to the research institute and those randomized in the "pleasure" and "health" groups read a leaflet on healthy eating, using either a pleasure or a health orientation respectively. Participants in the control group had no leaflet to read. All participants had subsequently to choose four food items in a buffet offering both healthy and unhealthy foods. Results showed a group by diet quality interaction (p = 0.02). Among participants with lower diet quality (C-HEI score below 50), those in the pleasure and health groups were more likely than participants in the control group to choose a healthier main course (prevalence ratios (PR) 1.71, 95% CI 1.12-2.62 and 1.83, 95% CI 1.21-2.77 for the pleasure and health group respectively) and a healthier beverage (PR 1.67, 95% CI 1.02-2.71 and 1.66, 95% CI 1.02-2.72, respectively). No such effect was observed among participants with higher C-HEI scores. In conclusion, our results suggest that in people with sub-optimal dietary habits, pleasure-oriented messages and traditional health messages are both useful to favor healthy main course and beverage choices.

The Overall Awareness and Impact of the WIXX Multimedia Communication Campaign, 2012-2016.

Background: Evidence regarding the impact of physical activity (PA) communication campaigns among children is scarce. This study was aimed at examining the reach of the WIXX campaign and its impact on children's PA beliefs and behaviors. Methods: This study adopted a pre-posttest design. Children (9-13 y old) were recruited using a random digit dialing procedure. Self-reported outcomes included PA beliefs, trying new PAs, and meeting PA guidelines. WIXX awareness and survey periods were the treatment variables. Logistic regression analyses were conducted to examine the main effect of treatment variables and the time-specific impact of WIXX. Results: The campaign reached 80.3% of the children. Fully adjusted results showed that girls with high (odd ratio = 1.4; 95% confidence interval, 1.0-2.0) and moderate (odd ratio = 1.4; 95% confidence interval, 1.0-1.8) awareness were more likely to have tried new PAs. Results from the sensitivity analyses suggested that this positive result was due to strategies implemented during the second year of the campaign. No other significant association between exposure and outcomes was observed. Conclusions: The WIXX campaign was successful in reaching a significant proportion of children. Although some encouraging results were observed among girls, WIXX awareness was not associated with changes on the examined outcomes among boys.

Promoting Healthy Eating in Adults: An Evaluation of Pleasure-Oriented versus Health-Oriented Messages.

BACKGROUND: Existing initiatives to promote healthy eating remain largely ineffective as individuals struggle to adhere to dietary recommendations. Therefore, challenging the strategies currently used is of significant importance. Recent studies have indicated the potential of an approach oriented towards eating pleasure to promote the consumption of healthy foods. OBJECTIVES: The aim of this study was to compare perceptions and the potential effect of pleasure-oriented and health-oriented messages promoting healthy eating among French-Canadians. METHODS: Two leaflets similar in all respects, except for the message orientation (pleasure or health), were developed. Perceived message orientation and effectiveness, perceptions towards healthy eating as well as emotions, attitude towards healthy eating, and intention to eat healthily were evaluated. A total of 100 adults (50% women; mean ± SD age 45.1 ± 13.0 y) were randomly assigned to read 1 of the 2 leaflets (pleasure: n = 50; health: n = 50). Questionnaires were completed online and data were also collected at a visit made to the Institute of Nutrition and Functional Foods. RESULTS: The difference in message orientation (pleasure compared with health) was well perceived by participants (P ≤ 0.01). The pleasure-oriented message was successful in inducing the perception that eating healthy can be pleasurable (pre- compared with post-reading; P = 0.01). Perceived message effectiveness and induced emotions in response to reading were similar between leaflets. Both messages significantly improved global attitude towards healthy eating (P ≤ 0.01) and increased intention to eat healthily (P < 0.001). Additional analyses showed that the affective attitude towards healthy eating increased more after reading the pleasure leaflet than the health leaflet (P = 0.05), whereas the health message tended to improve cognitive attitude more than the pleasure leaflet (P = 0.06). CONCLUSIONS: These findings suggest that the leaflets would be appropriate to promote healthy eating through 2 distinct approaches (health and pleasure paradigms) and propose that different effects on attitude could be observed from these 2 approaches.

Recall and understanding of a communication campaign designed to promote positive parenting and prevent child maltreatment.

Evidence-based parenting support programs are among effective strategies for preventing child maltreatment. The launch of mass media campaigns accompanying the implementation of such programs has been recommended to optimize reach and parent enrollment. This paper focuses on a communication campaign developed to support the implementation of the Triple P - Positive Parenting Program in two French-Canadian communities. Proximal outcomes (recall and understanding) were assessed through a randomized telephone survey conducted between January and April 2017 among 1029 mothers of children aged 6 months to 8 years. Distribution and correlates of the respondents' recall and understanding of the campaign were examined. Results show that 32.1% of respondents recalled having seen the campaign material. Among these, a large majority reported having understood the intended messages (parenting difficulties are normal, seeking help is the right thing to do, and/or effective support is available). However, some respondents also retained unintended messages blaming parents and/or children, and almost half the sample retained mixed messages (intended and unintended). Multivariate logistic regression analyses revealed that community of residence, annual household income, and psychological aggression towards the child at home were three significant correlates of campaign recall + intended messages understood. None of the examined factors were associated with recall + mixed messages understood. Findings suggest a neighborhood effect on the proximal outcomes of the campaign, and a slightly higher reach and understanding among better-off families as well as families struggling with psychologically violent parenting practices. These results are discussed in light of the outcomes of similar campaigns.

Is eating pleasure compatible with healthy eating? A qualitative study on Quebecers' perceptions.

Given that traditional interventions promoting the adoption of a healthy diet are having limited impacts on the population's food choices and eating behaviours, researchers and health practitioners could explore alternative strategies such as the use of eating pleasure to promote healthy eating. To inform future interventions using this approach, this study aimed to explore how a sample of Quebecers perceives and defines eating pleasure and healthy eating. Specific objectives were to verify what commonalities can be found between their definitions of eating pleasure and healthy eating, and what differences can be observed in their answers based on their sex and body mass index (BMI). Twelve focus groups were conducted in Quebec City, Canada, among women and men with a normal weight and with obesity (n = 92). Verbatim transcripts were double-coded using NVivo10. Participants mostly defined eating pleasure through food characteristics related to sensory qualities and psychosocial contexts. In contrast, they mostly mentioned food characteristics related to nutritional quality and ways to regulate eating behaviours to define healthy eating. Most salient perceptions were similar among subgroups based on sex or BMI. Results showed that in participants' perceptions, the concepts of eating pleasure and healthy eating were different, but appeared to be mostly compatible, which makes the integration of eating pleasure a promising avenue for interventions promoting healthy eating.

Efficacy of school-based interventions aimed at decreasing sugar-sweetened beverage consumption among adolescents: a systematic review.

OBJECTIVE: To verify the efficacy of school-based interventions aimed at reducing sugar-sweetened beverage (SSB) consumption among adolescents in order to develop or improve public health interventions. DESIGN: Systematic review of interventions targeting adolescents and/or the school environment. SETTING: The following databases were investigated: MEDLINE/PubMed, PsycINFO, CINAHL and EMBASE. Proquest Dissertations and Theses was also investigated for unpublished trials. SUBJECTS: Adolescents were defined as individuals between the ages of 12 and 17 years. RESULTS: A total of thirty-six studies detailing thirty-six different interventions tested among independent samples (n 152 001) were included in the review. Twenty interventions were classified as educational/behavioural and ten were classified as legislative/environmental interventions. Only six interventions targeted both individuals and their environment. Over 70 % of all interventions, regardless of whether they targeted individuals, their environment or both, were effective in decreasing SSB consumption. Legislative/environmental studies had the highest success rate (90·0 %). Educational/behavioural interventions only and interventions that combined educational/behavioural and legislative/environmental approaches were almost equally effective in reducing SSB consumption with success rates of 65·0 and 66·7 %, respectively. Among the interventions that had an educational/behavioural component, 61·5 % were theory-based. The behaviour change techniques most frequently used in interventions were providing information about the health consequences of performing the behaviour (72·2 %), restructuring the physical environment (47·2 %), behavioural goal setting (36·1 %), self-monitoring of behaviour (33·3 %), threat to health (30·6 %) and providing general social support (30·6 %). CONCLUSIONS: School-based interventions show promising results to reduce SSB consumption among adolescents. A number of recommendations are made to improve future studies.

Correlates of Initial Recall of a Multimedia Communication Campaign to Promote Physical Activity among Tweens: the WIXX Campaign.

This study examined factors associated with children's and parents' recall of a communication campaign aimed at promoting children's physical activity. A cross-sectional population-based telephone survey was conducted among 1001 children and their parents. Respondents were recruited through a random digit dialing procedure. Respondents' recall of the campaign, beliefs, sociodemographics as well as levels of physical activity and sedentary behaviors were self-reported. Logistic regression analyses were conducted for tweens and their parents separately. Girls (odds ratio [OR] = 2.1; 95%confidence interval (CI): 1.3, 3.5) were more likely to have unaided recall when compared to boys. Tweens in primary school (OR = 1.9; 95%CI: 1.0, 3.4 and OR = 2.1; 95%CI: 1.4, 3.0) and those speaking French (OR = 3.3; 95%CI: 1.4, 8.1 and OR = 2.9; 95%CI: 1.8, 4.7) were more likely to have unaided and aided recall, respectively. Among parents, tweens' unaided (OR = 12.0; 95%CI: 5.2, 28.1) and aided (OR = 3.3; 95%CI: 1.5, 7.3) recall, obesity status (OR = 2.6; 95%CI: 1.3, 5.3), and low income (OR = 5.2; 95%CI: 1.9, 14.3) were positively associated with recall. Additional beliefs were associated with tweens' and parents' recall of the campaign. The association between sex, language, and recall is in line with the branding strategy adopted and no clear evidence for communication inequalities was observed.