Randomised controlled trial of real-time feedback and brief coaching to reduce indoor smoking.

BACKGROUND: Previous secondhand smoke (SHS) reduction interventions have provided only delayed feedback on reported smoking behaviour, such as coaching, or presenting results from child cotinine assays or air particle counters. DESIGN: This SHS reduction trial assigned families at random to brief coaching and continuous real-time feedback (intervention) or measurement-only (control) groups. PARTICIPANTS: We enrolled 298 families with a resident tobacco smoker and a child under age 14. INTERVENTION: We installed air particle monitors in all homes. For the intervention homes, immediate light and sound feedback was contingent on elevated indoor particle levels, and up to four coaching sessions used prompts and praise contingent on smoking outdoors. Mean intervention duration was 64 days. MEASURES: The primary outcome was 'particle events' (PEs) which were patterns of air particle concentrations indicative of the occurrence of particle-generating behaviours such as smoking cigarettes or burning candles. Other measures included indoor air nicotine concentrations and participant reports of particle-generating behaviour. RESULTS: PEs were significantly correlated with air nicotine levels (r=0.60) and reported indoor cigarette smoking (r=0.51). Interrupted time-series analyses showed an immediate intervention effect, with reduced PEs the day following intervention initiation. The trajectory of daily PEs over the intervention period declined significantly faster in intervention homes than in control homes. Pretest to post-test, air nicotine levels, cigarette smoking and e-cigarette use decreased more in intervention homes than in control homes. CONCLUSIONS: Results suggest that real-time particle feedback and coaching contingencies reduced PEs generated by cigarette smoking and other sources. TRIAL REGISTRATION NUMBER: NCT01634334; Post-results.

Faith-based intervention to increase fruit and vegetable intake among Koreans in the USA: a feasibility pilot.

OBJECTIVE: In the USA, adults of Korean descent tend to eat fewer vegetables than adults in South Korea. The present pilot study examined the feasibility of developing and implementing a faith-based intervention to improve knowledge, attitudes and intake of fruit and vegetables (F&V) for Koreans in the USA. DESIGN: Feasibility pilot using a cluster-randomized intervention trial design. The multicomponent intervention included motivational interviewing sessions by telephone and church-based group activities. SETTING: Eleven of the largest Korean churches in Southern California. SUBJECTS: Adults (n 71) from the eleven Korean churches. RESULTS: Feasibility was demonstrated for the study procedures, including recruitment of churches and individual participants. Allocating time throughout the study for church collaboration and having a study church coordinator to coordinate multiple churches were crucial. Participants' attendance at church activities (89 %) and participation by pastors and fellow churchgoers exceeded expectations. Participants' use of intervention materials was high (94 % or above) and satisfaction with coaching sessions was also high (75 % or above). Having a centralized coach trained in motivational interviewing, instead of one at each church, proved practical. Pilot results are promising for F&V knowledge, attitudes and behaviours. The intervention group improved knowledge and intake of the recommended amounts of F&V, above that of the control group. CONCLUSIONS: This pilot suggests that Koreans in the USA can be reached through their church and that a faith-based intervention study can be implemented to increase F&V intake. Preliminary results for the intervention appear promising but further research is needed to properly evaluate its efficacy.

Design of the CHARGE study: A randomized control trial evaluating a novel treatment for Veterans with binge eating disorder and overweight and obesity.

A large number of Veterans experience binge eating and overweight or obesity, which are associated with significant health and psychological consequences. The gold-standard program for the treatment of binge eating, Cognitive Behavioral Therapy (CBT), results in decreases in binge eating frequency but does not result in significant weight loss. We developed the Regulation of Cues (ROC) program to reduce overeating and binge eating through improvement in sensitivity to appetitive cues and decreased responsivity to external cues, an approach that has never been tested among Veterans. In this study, we combined ROC with energy restriction recommendations from behavioral weight loss (ROC+). This study is a 2-arm randomized controlled trial designed to evaluate the feasibility and acceptability of ROC+, and to compare the efficacy of ROC+ and CBT on reduction of binge eating, weight, and energy intake over 5-months of treatment and 6-month follow-up. Study recruitment completed in March 2022. One hundred and twenty-nine Veterans were randomized (mean age = 47.10 (sd = 11.3) years; 41% female, mean BMI = 34.8 (sd = 4.7); 33% Hispanic) and assessments were conducted at baseline, during treatment and at post-treatment. The final 6-month follow-ups will be completed in April 2023. Targeting novel mechanisms including sensitivity to internal cures and responsivity to external cues is critically important to improve binge eating and weight-loss programs among Veterans. Clinicaltrials.govNCT03678766.

Randomized Trial to Reduce Air Particle Levels in Homes of Smokers and Children.

INTRODUCTION: Exposure to fine particulate matter in the home from sources such as smoking, cooking, and cleaning may put residents, especially children, at risk for detrimental health effects. A randomized clinical trial was conducted from 2011 to 2016 to determine whether real-time feedback in the home plus brief coaching of parents or guardians could reduce fine particle levels in homes with smokers and children. DESIGN: A randomized trial with two groups-intervention and control. SETTING/PARTICIPANTS: A total of 298 participants from predominantly low-income households with an adult smoker and a child aged <14 years. Participants were recruited during 2012-2015 from multiple sources in San Diego, mainly Women, Infants and Children Program sites. INTERVENTION: The multicomponent intervention consisted of continuous lights and brief sound alerts based on fine particle levels in real time and four brief coaching sessions using particle level graphs and motivational interviewing techniques. Motivational interviewing coaching focused on particle reduction to protect children and other occupants from elevated particle levels, especially from tobacco-related sources. MAIN OUTCOME MEASURES: In-home air particle levels were measured by laser particle counters continuously in both study groups. The two outcomes were daily mean particle counts and percentage time with high particle concentrations (>15,000 particles/0.01 ft3). Linear mixed models were used to analyze the differential change in the outcomes over time by group, during 2016-2017. RESULTS: Intervention homes had significantly larger reductions than controls in daily geometric mean particle concentrations (18.8% reduction vs 6.5% reduction, p<0.001). Intervention homes' average percentage time with high particle concentrations decreased 45.1% compared with a 4.2% increase among controls (difference between groups p<0.001). CONCLUSIONS: Real-time feedback for air particle levels and brief coaching can reduce fine particle levels in homes with smokers and young children. Results set the stage for refining feedback and possible reinforcing consequences for not generating smoke-related particles. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01634334.

Fine particles in homes of predominantly low-income families with children and smokers: Key physical and behavioral determinants to inform indoor-air-quality interventions.

Children are at risk for adverse health outcomes from occupant-controllable indoor airborne contaminants in their homes. Data are needed to design residential interventions for reducing low-income children's pollutant exposure. Using customized air quality monitors, we continuously measured fine particle counts (0.5 to 2.5 microns) over a week in living areas of predominantly low-income households in San Diego, California, with at least one child (under age 14) and at least one cigarette smoker. We performed retrospective interviews on home characteristics, and particle source and ventilation activities occurring during the week of monitoring. We explored the relationship between weekly mean particle counts and interview responses using graphical visualization and multivariable linear regression (base sample n = 262; complete cases n = 193). We found associations of higher weekly mean particle counts with reports of indoor smoking of cigarettes or marijuana, as well as with frying food, using candles or incense, and house cleaning. Lower particle levels were associated with larger homes. We did not observe an association between lower mean particle counts and reports of opening windows, using kitchen exhaust fans, or other ventilation activities. Our findings about sources of fine airborne particles and their mitigation can inform future studies that investigate more effective feedback on residential indoor-air-quality and better strategies for reducing occupant exposures.

Meal and snack patterns are associated with dietary intake of energy and nutrients in US adults.

OBJECTIVE: This study was undertaken to test the hypothesis that specific meal and snack patterns are associated with selected nutrient intakes in US adults. DESIGN: Using the 24-hour dietary recall from the Third National Health and Nutrition Examination Survey, meal and snack patterns were described in relation to nutrient intakes. SUBJECTS: The study included US adults aged 20 years or older (n=15,978). STATISTICAL ANALYSES PERFORMED: All statistical analyses accounted for the survey design and sample weights. Linear regression analyses controlled for confounding factors, including energy intakes. Wald F tests were used for determination of significance between means of nutrient intakes by daily eating frequency or meal pattern groups. RESULTS: Daily eating frequency was positively related to carbohydrate, folic acid, vitamin C, calcium, magnesium, iron, potassium, and fiber intakes and inversely related to protein, total fat, cholesterol, and sodium intakes. Meal patterns were further categorized into the five most commonly reported meal and snack combinations by population percentages including breakfast (B), lunch (L), dinner (D), and > or =2 snacks (S) (31.6%); B, L, D and 1 S (15.4%); B, D and > or =2 S (13.1%); B, L, D (8.3%); and L, D and > or =2 S (7.6%). Groups reporting B, L, D and 1 S and B, L, D and > or =2 S had the highest intakes of all micronutrients examined except cholesterol, vitamin B-6, and sodium. Breakfast skippers (L, D and > or =2 S) had the lowest intakes of all micronutrients examined except sodium. CONCLUSIONS: Findings from this cross-sectional survey suggest that meal and snack patterns may be markers for nutrient intakes and therefore diet quality. Complete nutrient intakes should be considered in investigations of meal patterns and health outcomes.

Youth receiving orthodontic care are not immune to poor diet and overweight: a call for dental providers to participate in prevention efforts.

OBJECTIVES: While obesity is common in the US, disparities exist. Orthodontic samples are assumed to be more affluent than the general population and not in need of assistance in developing or maintaining healthy lifestyles. This paper evaluates the need of the orthodontic population for intervention by examining diet and weight status of an orthodontic patient sample and describes a role for dental clinicians in obesity prevention efforts. METHODS: 552 patients age 8-14 years, 54% female, 51% non-Hispanic white, 26% Hispanic were recruited from orthodontic practices in Southern California to participate in a randomized controlled trial of clinician-delivered health promotion. Height, weight, demographics, and diet were recorded. Chi-Square analyses were used to test for differences at baseline by gender, age, ethnicity, and income. RESULTS: 13% of the sample was overweight and 9% was obese. Males had a higher rate of obesity than females. Lower income youth had a higher rate than higher income youth. Hispanic youth had a higher rate than non-Hispanic white youth. Failure to meet national dietary guidelines was common, differing significantly by demographic group. CONCLUSIONS: Within a sample not typically thought of as needing assistance, nearly 25% were overweight or obese and the majority failed to meet dietary recommendations. While most patients could benefit from intervention, male, Hispanic, and lower income groups were in greatest need of assistance. Dental providers, who see youth frequently and already discuss nutrition in the context of oral health, have the opportunity to contribute to obesity prevention.

Is consumption of breakfast associated with body mass index in US adults?

OBJECTIVE: To test the hypothesis that breakfast consumption is associated with weight status measured by body mass index in US adults. DESIGN: Analyses of data from the National Health and Nutrition Examination Survey, 1999-2000. PARTICIPANTS/SETTING: Men and women aged > or = 19 years (N=4,218), excluding pregnant and/or lactating women. STATISTICAL ANALYSES PERFORMED: SAS (release 8.1, 2000, SAS Institute Inc, Cary, NC) and SUDAAN (release 8.0.2, 2003, Research Triangle Institute, Research Triangle Park, NC) software were used to calculate sample-weighted means, standard errors, and population percentages of breakfast consumers. Multiple logistic and linear regression models, with controls for covariates, were used to determine the predictability of body mass index from breakfast consumption and from inclusion of ready-to-eat cereal (RTEC) in the breakfast meal. RESULTS: Breakfast consumers were more likely than breakfast nonconsumers to be older, female, white, nonsmokers, regular exercisers, and trying to control their weight. For women, daily energy intake was higher among breakfast consumers than among breakfast nonconsumers; for both men and women, energy intake from fat among RTEC breakfast consumers was significantly lower than among non-RTEC breakfast consumers, whereas energy from carbohydrate among RTEC breakfast consumers was significantly higher than among non-RTEC breakfast consumers. For women, the odds ratios for BMI > or = 25 were lower for breakfast consumers (odds ratio = 0.76) and RTEC breakfast consumers (odds ratio = 0.70) compared with breakfast nonconsumers and non-RTEC breakfast consumers, respectively, after adjusting the models for covariates. When RTEC consumption was added as a covariate, breakfast consumers no longer exhibited significantly lower odds ratios compared with breakfast nonconsumers. Furthermore, regression analyses supported an inverse association between RTEC breakfast consumption and body mass index in women (regression coefficient = -0.37, P<.01) after adjusting for covariates. CONCLUSIONS: When we document the association of breakfast consumption with lower prevalence of overweight and obesity, types of meal should be considered as an important determinant. RTEC breakfast consumption, associated with a desirable macronutrient profile for preventing obesity, predicted weight status in women, but not in men. In addition to sex difference in the association of breakfast consumption and RTEC breakfast consumption with lower prevalence of overweight, the effects of physiological variables and health-related behaviors on the relationship between total and RTEC intake at breakfast and weight status, remain to be established.

Reliability and validity of nutrition knowledge, social-psychological factors, and food label use scales from the 1995 Diet and Health Knowledge Survey.

OBJECTIVE: To test the reliability and validity of scales on nutrition knowledge, social-psychological factors, and use of food labels developed from the 1995 Diet and Health Knowledge Survey (DHKS) questions. DESIGN: The 1995 DHKS questions within a section were pooled together as a scale and their reliability and validity were examined. PARTICIPANTS: US adults (> or =20 years) in the 1995 DHKS who responded to questions selected for this study (n = 1196). VARIABLES: Nutrition knowledge about the diet-disease relationship and nutrient content of products, perceived barriers and benefits of food labels, perceived ease of understanding food labels, food label use, and importance of healthful eating. ANALYSIS: Scales validity, Cronbach alpha, item total correlation, alpha if the item was deleted, and discriminant, convergence, and correspondence validity. RESULTS: Scales on perceived ease of understanding the food label, benefits of using food labels, food label use, and importance of healthful eating were reliable (Cronbach alpha =.78,.82,.91, and.82, respectively) and valid. CONCLUSION AND IMPLICATIONS: Accurate findings and interpretation of survey data depend on the use of reliable and valid instruments. This study identified the scales in the DHKS that can substantiate the conclusion on which effective nutrition education strategies should be established.

Developing and Selecting Auditory Warnings for a Real-Time Behavioral Intervention.

Real-time sensing and computing technologies are increasingly used in the delivery of real-time health behavior interventions. Auditory signals play a critical role in many of these interventions, impacting not only behavioral response but also treatment adherence and participant retention. Yet, few behavioral interventions that employ auditory feedback report the characteristics of sounds used and even fewer design signals specifically for their intervention. This paper describes a four-step process used in developing and selecting auditory warnings for a behavioral trial designed to reduce indoor secondhand smoke exposure. In step one, relevant information was gathered from ergonomic and behavioral science literature to assist a panel of research assistants in developing criteria for intervention-specific auditory feedback. In step two, multiple sounds were identified through internet searches and modified in accordance with the developed criteria, and two sounds were selected that best met those criteria. In step three, a survey was conducted among 64 persons from the primary sampling frame of the larger behavioral trial to compare the relative aversiveness of sounds, determine respondents' reported behavioral reactions to those signals, and assess participant's preference between sounds. In the final step, survey results were used to select the appropriate sound for auditory warnings. Ultimately, a single-tone pulse, 500 milliseconds (ms) in length that repeats every 270 ms for 3 cycles was chosen for the behavioral trial. The methods described herein represent one example of steps that can be followed to develop and select auditory feedback tailored for a given behavioral intervention.