Characteristics of Smartphone Applications for Nutrition Improvement in Community Settings: A Scoping Review

Reproduced by permission of Oxford University Press https://academic.oup.com Copyright © 2019 American Society for NutritionSmartphone applications are increasingly being used to support nutrition improvement in community settings. However, there is a scarcity of practical literature to support researchers and practitioners in choosing or developing health applications. This work maps the features, key content, theoretical approaches, and methods of consumer testing of applications intended for nutrition improvement in community settings. A systematic, scoping review methodology was used to map published, peer-reviewed literature reporting on applications with a specific nutrition-improvement focus intended for use in the community setting. After screening, articles were grouped into 4 categories: dietary self-monitoring trials, nutrition improvement trials, application description articles, and qualitative application development studies. For mapping, studies were also grouped into categories based on the target population and aim of the application or program. Of the 4818 titles identified from the database search, 64 articles were included. The broad categories of features found to be included in applications generally corresponded to different behavior change support strategies common to many classic behavioral change models. Key content of applications generally focused on food composition, with tailored feedback most commonly used to deliver educational content. Consumer testing before application deployment was reported in just over half of the studies. Collaboration between practitioners and application developers promotes an appropriate balance of evidence-based content and functionality. This work provides a unique resource for program development teams and practitioners seeking to use an application for nutrition improvement in community settings

Development and Evaluation of Let\u27s Eat Smart: a Pilot School-Based Nutrition Intervention for Elementry School Children in Kuwait

Due to nutrition transition, the prevalence of childhood obesity is increasing significantly worldwide especially in affluent developing countries such as Kuwait. Obesity is associated with adverse chronic health conditions and financial burdens which provides an incentive for prevention. The objective of the study was to examine the effectiveness of a multi-component school-based nutrition intervention designed to improve healthy eating knowledge, attitudes, self efficacy and dietary behaviors among fourth and fifth graders in Kuwait. The Let\u27s Eat Smart program was based on the social cognitive theory and used short interactive lessons, DVD sessions, posters, food models and parental letters to promote a healthy lifestyle message among fourth and fifth graders. Let\u27s Eat Smart was delivered to 110 students in the English Playgroup and Primary School. Surveys and 3-day food-records were collected on pre- and post-intervention. Surveys assessed nutrition knowledge, attitudes, dietary behaviors and self efficacy while diet records were analyzed to examined intake of food groups. Additionally, program evolutions were collected on post-intervention. A paired t-test was used to analyze the change from pre- to post-intervention. Eighty four students completed all requirements of the program and were included in the quantitative analysis, while 95 students were included in the qualitative analysis of the program evaluation. After the intervention, students reported high levels of knowledge (p \u3c .0001), positive attitude toward a healthy lifestyle (p \u3c .04) and higher levels of self efficacy toward healthy eating (p \u3c .01). There was no significant change in dietary practices assessed in the survey except for fast food consumption where there was a significant decrease in consumption after the intervention (p \u3c .001). Diet-records analysis shoa significant increase in fruits intake (p \u3c .02) and vegetables intake (p \u3c .001) after the intervention. The overall students\u27 evaluation of the program was positive as 90.5% were satisfied and would like to have more nutrition lessons. Due to its apparent impact on children, Let\u27s Eat Smart is an effective school-based intervention approach to address prevention of childhood obesity in Kuwaiti schools

Self-Regulation of Saturated Fat Intake in Blue-Collar Employees: A Randomized Intervention Study

Blue-collar employees, compared to white-collar workers, are more vulnerable to developing chronic illness and are less likely to make healthy food choices. Saturated fat intake, an indicator of an unhealthy diet, is a major contributor to disease morbidity, mortality, and health care costs. Interventions directed at increasing self-regulatory skills for health behaviors could possibly serve to bolster one\u27s sense of personal control in psychological and socio-economic realms. The current study was a 2 x 3 between-subjects repeated-measures randomized experimental design that examined the efficacy of a Self-regulation skill + Education intervention against an Education Only condition over a 6-week period, with assessments at baseline, week 4 (end of intervention), and week 6 (post-intervention). Outcome variables included saturated fat intake, self-efficacy for reducing saturated fat intake, and self-regulation for controlled eating. Blue-collar employees (N=54) at UWM were randomized to either condition. Participants in both groups had an equal number of individual in-person meetings. Both groups received the saturated fats information booklet, which discussed what saturated fat is, identified items high in saturated fats, and provided information on how to reduce this element in one\u27s diet. Self-regulation skill + Education participants also took part in a 4-week self-regulation skills training that involved selecting saturated fat reduction goals, self-monitoring, identifying barriers and strategies, self-administering rewards, evaluating progress and revising goals. Study procedures followed a carefully designed manual to ensure standardized intervention delivery; all participants were to receive equivalent educational informational with the intervention group receiving additional self-regulatory skills training. Mixed ANOVA analyses showed that significant differences emerged between groups. Specifically, the Self-regulation skill + Education group reported significantly lower saturated fat intake and greater self-regulation at the end of the intervention and post-intervention. The intervention group also reported significantly higher self-efficacy for saturated fat intake post-intervention. The present study has extended self-regulation research to saturated fat intake behavior within a low socio-economic status work group. The features of the Self-Regulation + Education intervention point to simple yet meaningful efforts for health behavior change and hold empirical and practical value. Research findings highlight that self-regulation training is an essential component of effective health behavior change and should be an integral component of multi-level illness prevention and health promotion efforts

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Spillover Effect:Do Siblings Reap the Benefits?

abstract: Objective: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a federally-funded program that provides supplemental food packages, nutrition education, and healthcare referrals to low-income women, infants, and children under 5, who are at the highest nutritional risk. This study explores if household WIC participation is associated with healthier dietary behaviors among age-ineligible children (5-18-years-old) in WIC households. Consumption frequency of fruits, vegetables, 100% juice, sugar-sweetened beverages (SSBs), and energy-dense snacks (sweet and salty snacks) among children from WIC and income-qualifying non-WIC households were compared. Methods: Data were obtained from two cross-sectional panels (2009-10 and 2014) of the New Jersey Child Health Study conducted in four low-income New Jersey cities. Questions from previously validated surveys assessed consumption frequency of fruits, vegetables, SSBs, and sweet and salty snacks. Analyses were confined to 570 children between 5-18 yrs; of which 365 (5-11 yrs: 237, 12-18 yrs: 128) resided in WIC participating households and 205 (5-11 yrs: 138, 12-18 yrs: 67) in income-qualifying non-WIC households. Over half of the sample was African American and 43% were Hispanic. Multivariable analyses were conducted to compute incidence rate ratios (IRRs) using negative binomial regression to compare the differences in eating behaviors of children in WIC vs. Non-WIC households Results: Household WIC participation was associated with a slightly higher frequency of vegetable consumption among 12-18-year-old children (IRR= 1.25, p=.05); differences were significant among older males (12-18-years-old) (p=.006), and not in females. Frequency of 100% juice consumption was significantly higher among younger females (5-11-years-old) in WIC households who consumed juice about 44% more frequently (p=.02) compared to similar age girls in non-WIC households. Hispanic children in WIC households reported a lower frequency of SSBs consumption (p=.01); this association was only true among males (p=.02). Conclusions: Household WIC participation is associated with healthier dietary behaviors among age-ineligible children living in the households, suggesting a positive spillover effect of the program. Proposed changes to WIC packages are likely to have dietary implications not only for WIC participants but also for non-participating children residing in WIC households,Dissertation/ThesisMasters Thesis Nutrition 201

Understanding and improving Chinese adolescent snacking using behaviour change and a mindfulness-based approach

Background: Despite the dramatic increase in the prevalence of childhood overweight/obesity in China, there is a lack of high-quality evidence for effective intervention strategies to tackle this issue. Unhealthy snacking has been suggested as a major part of unhealthy diets contributing to overweight/obesity, which is a potential target of weight-loss interventions for Chinese adolescents. Evidence suggests that mindfulness-based approaches have potentials in improving dietary intakes and promoting weight loss. Aim: To generate a better understanding of adolescent snacking, and based on this, to develop and feasibility test a mindfulness-based behaviour change intervention to promote weight loss among overweight Chinese adolescents. Method: Multiple approaches were employed, including a cross-cultural survey and a focus group study aiming at understanding adolescent snacking; a think-aloud study and a validation study aiming at producing a culturally appropriate measure of mindful eating in the Chinese population; and intervention development and a feasibility study to evaluate its feasibility, acceptability and preliminary effects. Findings and Conclusions: This research suggested the importance of mindful eating in predicting and improving adolescent snacking. The theory of planned behaviour showed efficient in explaining adolescent snacking, and cultural context should be taken into account applying this theory. Chinese adolescent snacking is greatly influenced by subjective norms, while snacking of UK adolescents are largely habitual and less influenced by cognitive beliefs. The cultural differences suggest different intervention strategies for each group. A revised Chinese version of Mindful Eating Questionnaire was developed, which exhibited good psychometric properties in a sample of Chinese college students. Finally, a mindfulness-based snacking intervention was developed incorporating components of nutrition education, mindful eating and planning. A feasibility test provided evidence supporting the feasibility, acceptability and preliminary effects of this intervention on decreasing unhealthy snacking and promoting weight loss among overweight Chinese adolescents. A full-scale RCT to examine intervention effectiveness is warranted

Nutrition Education to Minimize Health Risk: Approaches for Teaching College Students and Female High School Athletes

Adolescence is a time of increased control over food choices and dietary practices. Participating in high school sports or attending college presents unique nutritional concerns and health risks. Some female high school athletes have low energy availability (consuming inadequate calories to compensate for exercise energy expenditure), which can result in menstrual dysfunction, bone loss, and injury, also known as the female athlete triad (Triad). College students who consume diets low in fruits and vegetables and high in fast food are at increased risk for weight gain, chronic disease, and some cancers. Nutrition education interventions that were tailored to the participants\u27 unique nutritional concerns yielded positive results such as increased Triad knowledge among female high school athletes and increased self-efficacy and readiness to change dietary behaviors among college students. Peer-led education was preferred by college students, but not by high school students

Effects of the Preschool-Based Family-Involving DAGIS Intervention on Family Environment: A Cluster Randomised Trial

Interventions promoting young children’s healthy energy balance-related behaviours (EBRBs) should also examine changes in the family environment as this is an important determinant that may affect the effectiveness of the intervention. This study examines family environmental effects of the Increased Health and Wellbeing in Preschools (DAGIS) intervention study, and whether these effects differed when considering three parental educational level (PEL) groups. The DAGIS intervention was conducted in preschools and involving parents in Southern Finland from September 2017 to May 2018. It was designed as a randomised trial, clustered at preschool-level. Parents of 3–6-year-olds answered questionnaires recording PEL, parental role modelling for EBRBs, and the family environment measured as EBRBs availability and accessibility. Linear Mixed Models with Repeated Measures were used in order to detect intervention effects. Models included group by time interactions. When examining intervention effects separated by PEL groups, models with three-level interactions (group × time-points × PEL) were evaluated. There was an interaction effect for the availability of sugary everyday foods and drinks (p = 0.002). The analyses showed that the control group increased availability (p = 0.003), whereas in the intervention group no changes were detected (p = 0.150). In the analysis separated by PEL groups, changes were found only for the accessibility of sugary treats at home; the high PEL control group increased the accessibility of sugary treats (p = 0.022) (interaction effect: p = 0.027). Hence, results suggest that the DAGIS multicomponent intervention had a limited impact on determinants for children’s healthy EBRBs, and no impact was found in the low PEL group

Effects of the Preschool-Based Family-Involving DAGIS Intervention on Family Environment: A Cluster Randomised Trial

Interventions promoting young children’s healthy energy balance-related behaviours (EBRBs) should also examine changes in the family environment as this is an important determinant that may affect the effectiveness of the intervention. This study examines family environmental effects of the Increased Health and Wellbeing in Preschools (DAGIS) intervention study, and whether these effects differed when considering three parental educational level (PEL) groups. The DAGIS intervention was conducted in preschools and involving parents in Southern Finland from September 2017 to May 2018. It was designed as a randomised trial, clustered at preschool-level. Parents of 3–6-year-olds answered questionnaires recording PEL, parental role modelling for EBRBs, and the family environment measured as EBRBs availability and accessibility. Linear Mixed Models with Repeated Measures were used in order to detect intervention effects. Models included group by time interactions. When examining intervention effects separated by PEL groups, models with three-level interactions (group × time-points × PEL) were evaluated. There was an interaction effect for the availability of sugary everyday foods and drinks (p = 0.002). The analyses showed that the control group increased availability (p = 0.003), whereas in the intervention group no changes were detected (p = 0.150). In the analysis separated by PEL groups, changes were found only for the accessibility of sugary treats at home; the high PEL control group increased the accessibility of sugary treats (p = 0.022) (interaction effect: p = 0.027). Hence, results suggest that the DAGIS multicomponent intervention had a limited impact on determinants for children’s healthy EBRBs, and no impact was found in the low PEL group