Effectiveness and Feasibility of In-office versus Smartphone Text-delivered Nutrition Education in the College Setting: A Mixed-methods Pilot Study

Often, being away from home for the first time, coupled with limited knowledge regarding healthy eating behaviors, leads to poor food choices and an increased risk of obesity among college-aged young adults. These college students are prone to high-calorie diets and limited physical activity, putting them at risk for obesity, a physiologically, psychologically, and financially costly epidemic in the United States. College students use their cellular phones over eight and a half hours a day and cell phones are their primary means of information consumption outside of the classroom, suggesting that the phones would be a useful tool to provide nutrition education to this at-risk population. This mixed-methods randomized-controlled trial took place over eight weeks, between 9/15/15 and 12/2/15. The primary aims of this study were to assess the effectiveness and feasibility between an educational nutrition intervention delivered via smartphone texts and a traditional in-office setting for 18-22-year-old, overweight college students at the Sonoma State University Student Health Center. Using simple randomization, participants were assigned to one of two groups: text, or in-office. Participants in the in-office group received one-on-one nutrition counseling framed within the social cognitive theory by a registered nurse at the study onset, week two, and week four. Participants in the text group received the same information, broken up into weekly text messages with links to websites, YouTube, and explanations of content. Participant characteristics, including weight, height, and health behaviors (hours of sleep a night, number of fruits and vegetables per day), were assessed at the study onset (T1) and again at week two (T2), week four (T3), and week eight (T4). All participants were invited to take part in an in-depth, qualitative, face-to-face interview at the end of the study (T4). Nine participants completed both the trial and interviews. Two-thirds (66.7%, n=6) were in the text group, 66.7% (n=6) were female, 33.3% (n=3) were minorities, 66.7% lived on- campus, and 44.4% (n=4) took part in the university’s on-campus meal plan. No statistically significant differences were noted in participant characteristics, or health behaviors between the two groups throughout the study. Although no statistical significance was noted between the two groups with regard to weight change, the text group’s mean weight decreased from 188.25(sd=25.03) pounds to 184.58(sd=24.67) pounds while the in-office group’s mean weight increased from 254.00(sd=90.15) to 257.00(sd=94.14) pounds. Weight loss in the text group should be further evaluated as it may hold clinical significance for effectiveness of the intervention. Through qualitative interviews exploring participants’ experiences, four major themes emerged. All participants in the text group (n=6) stated that they felt there was a need for their method of education, they felt their method was effective, they would recommend their method, and their health behaviors changed positively. For the in-office group, all participants (n=3) said there was a need for their method of education, 67% (n=2) said it was effective, all would recommend it, and 67% stated that they changed their behaviors. Both the quantitative and qualitative findings of this study hold clinical significance as to the effectiveness and feasibility of text messages as a means of providing nutrition education in the college setting. Future research with larger sample sizes and a longer-term study are recommended for more statistical power and to determine the long-term benefits of these methods of nutrition education

Factors associated with self-competence and quality of life in Chinese-American children

The goal of this study was to examine factors associated with self-competence and quality of life in Chinese-American children. A cross-sectional design was used to examine factors associated with Chinese-American children’s self-competence (perception of their own competence) and quality of life. Body mass index was used to measure children’s relative weight. Children completed the Self-Perception Profile for Children, the Pediatric Quality of Life self-report, and the Children's Self-Administered Physical Activity Checklist. Parents provided demographic information and reported their level of acculturation. Sixty-five 8- and 10-year-old Chinese-American children (49% boys, 51% girls) and their parents participated in the study. Boys reported higher levels of competence in athletics than girls reported. Multivariate regression models reveal that an increased level of sedentary activity in Chinese American children contributes to low competence levels with respect to physical appearance and decreased quality of life in the social health domain. Increased BMI is related to decreased selfcompetence in physical appearance. Low levels of sedentary activity have a great influence on selfcompetence and quality of life in Chinese American children. The development of culturally appropriate programs that decrease sedentary activity and improve quality of life is critical for health promotion among Chinese Americans

Gender and ethnic disparities contributing to overweight in California adolescents

To explore differences in health behaviors and factors contributing to overweight among 12 to 17 year olds in California. Data from the 2005 California Health Interview Survey for 3,315 adolescents self-identified as Latino, Asian, or white were reviewed. Adolescents reported their weight, height, gender, ethnicity, parents’ educational level, household income, physical activity, sedentary activity, breakfast consumption, and family meals. Overall 34% of boys and 22% of girls in this study were overweight (>85th percentile for age and gender). Approximately 38% of Latinos, 25% of whites, and 16% of Asians were overweight. Latinos were more than twice as likely to be overweight as whites (2.07) and Asians (2.53). Younger adolescents (12–13 years old) and adolescents whose family income is less than 200% of the federal poverty level were more likely to be overweight. Low level of parental education is a risk factor for Latino and Asian girls and white and Latino boys. White girls with a lower socioeconomic status and white boys with more than 2 h daily of television, video, and computer time were more likely to be overweight. Results suggest gender and ethnic variations in factors that contribute to overweight in California adolescents. To influence the current overweight epidemic, clinicians must develop culturally sensitive and gender-specific interventions that address the unique needs of an ethnically diverse adolescent population

Risk Factors Contributing to Overweight, Decreased Physical Activity and Body Dissatisfaction in California Adolescents

ABSTRACTThe purpose of this descriptive cross-sectional study is to examine the factors that contribute to overweight, decreased physical activity and body dissatisfaction in the 12 to 17 year old, ethnically diverse California adolescent and to determine if there are differences among gender and race. Data from the 2005 California Health Interview Survey (CHIS) for adolescents self-identified as Latino, Asian, or White were reviewed. Adolescents reported weight, height, gender, ethnicity, parent education attainment, household income, physical activity, sedentary activity, breakfast consumption, family meals and body satisfaction. Parent information was also used in exploring factors contributing to decreased physical activity and these variables included parent physical activity, acculturation level and BMI. The main findings in this study were that gender and ethnic variations exist in factors contributing to overweight, decreased physical activity and body dissatisfaction in California adolescents. The key factors associated with both overweight and PA included age, gender, ethnicity, SES, screen time, and parent education attainment. The key risk factors that overlapped for body dissatisfaction and PA included general health status and BMI. A higher percentage of Latino adolescents (38%) compared to 25% of whites and 16% of Asians were overweight. Females are 1.5 times as likely to report decreased levels of physical activity compared with males. Asians were the least active and also reported the highest levels of sedentary activity. Across gender and ethnicity reports of poor/fair general health status and overweight were associated with body dissatisfaction. Latina females and Asian males were the least satisfied with their bodies. Overall, there seems to be a relationship between overweight, decreased physical activity and body dissatisfaction in California adolescents. The findings in this study support the need for development of culturally sensitive and gender specific interventions to improve the health behaviors in the adolescent population