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Nutrition for a Lifetime System©: A multimedia system for altering food supermarket shoppers' purchases to meet nutritional guidelines

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Nutrition for a Lifetime System©: A multimedia system for altering food supermarket shoppers' purchases to meet nutritional guidelines

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Abstract

The Nutrition for a Lifetime System(NLS) is a multimedia, public-access system housed in a kiosk in supermarkets designed to help shoppers decrease fat and increase fiber and fruits and vegetables in their food purchases in order to meet nutritional guidelines. In the present study, the NLS was modified from previous versions so that users' time was decreased to about 3–5 min per week, primarily consisting of viewing 10 weekly segments which used prompts, modeling, and prescriptive content plus interactions revolving around coupon offerings and selections. Coupon offerings were tied to program content, users' prior selections, and a nutrition priority order and were person-, store-, and timelimited. A monitoring system involving study participants' shopping receipts and an extensive nutrition database was used to track participants' food purchases and their nutritional content throughout the intervention. Participants, recruited at the supermarket, represented a cross-section by age and socioeconomic status of shoppers. All participants completed a baseline period (no NLS use.) Participants were then randomly assigned to an experimental (NLS use, N=54) or control (no NLS use; N=51) condition. The study's results showed the NLS significantly reduced fat and increased fiber and produce in NLS participants' purchases, with some evidence for maintenance at follow-up.

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... In almost half of the studies (16 studies), the goal was to increase sales of healthy products and the most targeted product category was fruits and vegetables, which was covered in 15 studies. Studies defined healthy products as fruit or vegetable [52][53][54][59][60][61][62][63][64][65][66][67][68][69][70], products with high nutritional "grade" (e.g., "3-star"or "green" rating) [57,[71][72][73][74][75][76][77][78], high fiber [61,62,70], low fat products [56,[79][80][81], low-calorie snacks [81] or healthy beverages (e.g., water or diet soda) [56,63]. ...
... In almost half of the studies (16 studies), the goal was to increase sales of healthy products and the most targeted product category was fruits and vegetables, which was covered in 15 studies. Studies defined healthy products as fruit or vegetable [52][53][54][59][60][61][62][63][64][65][66][67][68][69][70], products with high nutritional "grade" (e.g., "3-star"or "green" rating) [57,[71][72][73][74][75][76][77][78], high fiber [61,62,70], low fat products [56,[79][80][81], low-calorie snacks [81] or healthy beverages (e.g., water or diet soda) [56,63]. ...
... Eight studies targeted reduction in unhealthy food products, with reduction in fat (total fat or saturated fat) and sugar soda being the most targeted outcomes [55,56,[61][62][63]66,70,75,76,82,83]. Studies. ...
Article
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Grocery stores are important settings to promote healthier food and beverage choices. The present paper aims at reviewing the effectiveness of different types of in-store interventions and how they impact sales of different product category in real grocery stores. Systematic search was conducted in six databases. In-store interventions were categorized according to the framework by Kraak et al. (2017) into one or more of eight interventions (e.g., place, profile, portion, pricing, promotion, healthy default picks, prompting and proximity). This systematic theme-based review follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) data screening and selection. Thirty-six studies were included in the qualitative synthesis and 30 studies were included in the meta-analysis, representing 72 combinations of in-store interventions. The analysis demonstrates that interventions overall had small significant effect size (ES) using Cohen's d on food purchase behavior (d = 0.17, 95% CI [0.04, 0.09]), with largest ES for pricing (d = 0.21) and targeting fruits and vegetables (d = 0.28). Analysis of ES of in-store interventions show that pricing, and pricing combined with promotion and prompting, effectively impacted purchase behavior. Interventions significantly impacted both sales of healthy and unhealthy products and significantly increased sales of fruits and vegetables, healthy beverage and total volume of healthy products. Results should however be interpreted with some caution, given the relatively low quality of overall evidence and low number of studies and observations for some types of intervention. Further research exploring impact on different in-store interventions and targeting especially unhealthy products are needed.
... The five Eat4Life modules were formulated following principles and strategies from social cognitive theory (Bandura, 1997) and closely followed the format of a multimedia system we had developed that also focused on nutrition change (Anderson, Winett, Bickley, Rankin, Moore, Leahy, Harris, & Gerkin, 1997; Winett et al, 1997). Thus, each module provided a brief assessment of a girl's nutritional practices with regard to the target foods and information about the target foods, and suggested strategies to change specific practices. ...
... The five Eat4Life modules were formulated following principles and strategies from social cognitive theory (Bandura, 1997) and closely followed the format of a multimedia system we had developed that also focused on nutrition change (Anderson, Winett, Bickley, Rankin, Moore, Leahy, Harris, & Winett et al, 1997). Thus, each module provided a brief assessment of a girl's nutritional practices with regard to the target foods and information about the target foods, and suggested strategies to change specific practices. ...
... However, analyses using only the one common paper-and-pencil preassessment and the one common paper-andpencil postassessment showed similar results to the outcomes with all four data collection points. We have made the case in this report and a prior one (Winett et al., 1997) that computer-based systems with the objective of health behavior change will produce very minimal change unless the programs incorporate established, theoretically based change procedures into the programs. For example, the Eat4Life modules heavily relied on behavioral prescriptions and personalized goal setting and feedback as major vehicles for change. ...
Article
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The Eat4Life program is a linear series of five Internet-based modules that focuses on changing health behaviors and serves as an adjunct to health curriculums. The goals of the program involve increasing high school girls' con-sumption of regular meals, fruits and vegetables, and fiber and reducing the consumption of high-fat snacks, high-fat dairy products, and regular sodas. Additional goals include decreasing the fat grams and calories consumed from fast food and increasing the frequency and duration of exercise and activity. The modules involve text, graphics, and pictures with considerable interactions and use a number of established behavior change tactics such as personalization of content through frequent assessments, prescriptive strategies, and personalized goals and feedback. Girls using the modules as part of their health classes (N = 103) were compared to girls who were in health classes, but did not use the modules (N = 77). Across four cohorts of experimental and comparison classes, girls using the modules reported that they made relatively consistent changes in all nutrition areas except for reducing the consumption of high-fat dairy products. Similar consistent findings were found for changes in fast food consumption and aerobic conditioning activity. While it is important to develop measures to corroborate self-report indices and to sustain initial student changes, future work also needs to focus on Internet-based programs directed toward the mediators of change such as teachers.
... , youth nutrition and fitness (19), general health promotion (20), and adult nutrition (21,22). The development of computer-based interventions, however, must rest on a firm theoretical foundation to realize the potential for behavior change and risk reduction (23,24). ...
... One effective way to increase the accuracy of self-reported food frequency surveys is to collect them in conjunction with perceived or real verifiable objective data (28). Previous research with the NLS found that annotated food shopping receipts, collected over a period of time, can provide an objective, sensitive measure of nutrition behavior of individual food shoppers (21,22,25). In conjunction with a database of supermarket foods developed specifically to evaluate nutritional content of food purchases (21), supermarket receipts can provide rich data regarding the nutritional status of individuals and families whose diets consist largely of foods purchased at food stores. ...
... Previous research with the NLS found that annotated food shopping receipts, collected over a period of time, can provide an objective, sensitive measure of nutrition behavior of individual food shoppers (21,22,25). In conjunction with a database of supermarket foods developed specifically to evaluate nutritional content of food purchases (21), supermarket receipts can provide rich data regarding the nutritional status of individuals and families whose diets consist largely of foods purchased at food stores. For individuals who purchase a smaller proportion of foods at food stores, food shopping receipts are less sensitive to intervention-related dietary change (21,22,29). ...
Article
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This study examined the direct and mediated impact of a self-administered, computer-based intervention on nutrition behavior self-efficacy, and outcome expectations among supermarket food shoppers. The intervention, housed in kiosks in supermarkets and based on social cognitive theory, used tailored information and self-regulation strategies delivered in 15 brief weekly segments. The study sample (N = 277), stratified and randomly assigned to treatment or control, was 96% female, was 92% White, had a median annual income of about $35,000, and had a mean education of 14. 78 +/- 2.11 years. About 12% of the sample reported incomes of $20,000 or less, and about 20% reported 12 years or fewer of education. Analysis of covariance immediately after intervention and at a 4- to 6-month follow-up found that treatment led to improved levels of fat, fiber, and fruits and vegetables. Treatment also led to higher levels of nutrition-related self-efficacy, physical outcome expectations, and social outcome expectations. Logistic regression analysis determined that the treatment group was more likely than the control group to attain goals for fat, fiber, and fruits and vegetables at posttest and to attain goals for fat at follow-up. Latent variable structural equation analysis revealed self-efficacy and physical outcome expectations mediated treatment effects on nutrition. In addition, physical outcome expectations mediated the effect of self-efficacy on nutrition outcomes. Implications for future computer-based health promotion interventions are discussed.
... Due to this heterogeneity, it was possible to perform meta-analyses for only two outcomes: daily servings of fruits and vegetables and percentage of energy consumed from total fat. Fifteen 18,19,21,22,25,27,[31][32][33][35][36][37][38][39][40] of the 25 studies assessed one or both outcomes, and were therefore included in this review. Ten studies did not assess daily servings of fruits and vegetables or percentage of energy from total fat, and were thus excluded. ...
... These additional outcomes were also excluded. Study characteristics and results for the 20 studies with excluded outcomes [18][19][20][21][22][23][24][25][26]28,31,33,34,[36][37][38][39][40][41][42] are summarized in Table 2. ...
... Eleven of the 15 studies in the meta-analyses were conducted in the United States, 18,21,22,25,27,[31][32][33]36,37,40 two in Belgium, 19,39 one in the United States and Canada, 35 and one in France. 38 They were generally medium to large in size (median sample size, 674; range, 105 38 -5,042 37 ). ...
Article
Tailoring individualizes information to the receiver and provides a potential strategy for improving dietary intakes. The present systematic review summarizes evidence for the long-term (> or =6 months) effectiveness of tailored nutrition education for adults and includes priority population groups. Key electronic databases and relevant bibliographies were searched for trials measuring the following outcomes: nutrition-related health behaviors (e.g., dietary intake and food purchases) and anthropometric measures. Data synthesis was comprised of meta-analysis (for 15 trials including all population groups) and narrative review (for five trials of priority population groups). Overall, the quality of the studies was moderate to good. Tailored nutrition education was found to be a promising strategy for improving the diets of adults (including those in priority population groups) over the long term. However, future studies should ensure adequate reporting of research design and methods and reduce the chances of false-positive findings by using more objective measures of diet, clearly identifying the primary study outcome, and concentrating on outcomes most relevant to nutrition-related disease.
... Sixteen studies were randomised controlled trials, 14 were controlled before and after trials (CBA), one was a CBA with a non-equivalent comparison group [15] and one was a quasi-experimental repeated measures study [16]. Twelve studies had low risk of bias and were classified as strong [16][17][18][19][20][21][22][23][24][25][26][27], nine were moderate [28][29][30][31][32][33][34][35][36] and 11 were weak [15,[37][38][39][40][41][42][43][44][45][46] (Additional file 2: Table S2). The studies classified as weak were still included as they may still have made an important, if lesser, contribution. ...
... Six studies [22,35,36,37,38,43] offered monetary incentives to customers (Table 7). Monetary incentives included price discounts of 12.5% [22], 50% [35] or store coupon/ vouchers [36][37][38]43] valued from 50 cents per coupon [36,43] to $10 per week [38]. ...
... Six studies [22,35,36,37,38,43] offered monetary incentives to customers (Table 7). Monetary incentives included price discounts of 12.5% [22], 50% [35] or store coupon/ vouchers [36][37][38]43] valued from 50 cents per coupon [36,43] to $10 per week [38]. Five studies were conducted in the USA and one in New Zealand [22] (Additional file 5: Table S5). ...
Article
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Point-of-sale is a potentially important opportunity to promote healthy eating through nutrition education and environment modification. The aim of this review was to describe and review the evidence of effectiveness of various types of interventions that have been used at point-of-sale to encourage purchase and/or eating of healthier food and to improve health outcomes, and the extent to which effectiveness was related to intensity, duration and intervention setting. Records from searches in databases were screened and assessed against inclusion criteria. Included studies had risk of bias assessed. Intervention effectiveness was assessed for two outcomes: i) purchase and/or intake of healthier food options and/or nutrient intake; and ii) mediating factors that might effect the primary outcome. The search identified 5635 references. Thirty-two papers met the inclusion criteria. Twelve studies had low risk of bias and were classified as strong, nine were moderate and 11 were weak. Six intervention types and a range of different outcome measures were described in these papers: i) nutrition education and promotion alone through supermarkets/stores; ii) nutrition education plus enhanced availability of healthy food; iii) monetary incentive alone; iv) nutrition education plus monetary incentives; v) nutrition intervention through vending machines; and vi) nutrition intervention through shopping online. The evidence of this review indicates that monetary incentives offered to customers for a short-term look promising in increasing purchase of healthier food options when the intervention is applied by itself in stores or supermarkets. There was a lack of good quality studies addressing all other types of relevant point-of-sale interventions examining change in purchase and/or intake of healthier food options. There were few studies that examined mediating factors that might mediate the effect on the primary outcomes of relevant interventions. A range of intervention types have been used at point-of-sale to encourage healthy purchasing and/or intake of healthier food options and to improve health outcomes. There is a need for more well designed studies on the effectiveness of a range of point-of-sale interventions to encourage healthier eating and improve health outcomes, and of the mediating factors that might impact these interventions.
... Four RCT assessing the effectiveness of tailored nutrition education and employing objective outcome measures of diet were identified: one was undertaken in eight lowcost supermarkets in New Zealand (2010; n 1104) (6) ; one was an online intervention trial in Australia (2006; n 497) (7) ; and two were undertaken in supermarkets in the USA (1997 and 2001; n 105 and 296, respectively) (8,9) . The New Zealand and Australian trials used electronic supermarket sales data linked to a food and nutrient database to tailor the nutrition education intervention and assess trial outcomes. ...
... All tailored nutrition education intervention trials employing objective outcome measures compared tailored nutrition education v. no education (6,8,9) , except for the Australian trial (7) which compared tailored v. generic nutrition education. ...
... The New Zealand trial delivered packages of foodgroup-'themed' information to intervention participants by post (6) ; the Australian online trial provided participants with healthier alternatives for selected products containing . 1 % of total energy from saturated fat (7) ; and the US trials delivered 5-min education sessions through a kiosk housed in the supermarket. The US interventions also included discount coupons for healthier products (8,9) . Intensity of the intervention was substantially higher for the US trials compared with the Australian and New Zealand trials (fourteen or fifteen weekly sessions compared with a mean of three online shopping episodes and seven packages of mailed information, respectively). ...
Article
There has been a growing interest in tailored nutrition education over the previous decade, with a number of literature reviews suggesting this intervention strategy holds considerable potential. Nevertheless, the majority of intervention trials undertaken to date have employed subjective self-report outcome measures (such as dietary recalls). The aim of the present review is to further consider the likely true effect of tailored nutrition education by assessing the findings of tailored nutrition education intervention trials where objective outcome measures (such as sales data) have been employed. Four trials of tailored nutrition education employing objective outcome measures were identified: one was undertaken in eight low-cost supermarkets in New Zealand (2010; n 1104); one was an online intervention trial in Australia (2006; n 497); and two were undertaken in US supermarkets (1997 and 2001; n 105 and 296, respectively). Findings from the high-quality New Zealand trial were negative. Findings from the US trials were also generally negative, although reporting was poor making it difficult to assess quality. Findings from the high-quality online trial were positive, although have limited generalisability for public health. Trials employing objective outcome measures strongly suggest tailored nutrition education is not effective as a stand-alone strategy. However, further large, high-quality trials employing objective outcome measures are needed to determine the true effectiveness of this popular nutrition intervention strategy. Regardless, education plays an important role in generating social understanding and acceptance of broader interventions to improve nutrition.
... Personalized nutrition education plus path-to-purchase marketing (n ¼ 7) 83,201,206,210,212,214,215 Incentive program plus path-topurchase marketing (n ¼ 8) 47,182,199,200,[202][203][204]207 Incentive program plus personalized nutrition education plus prescription program (n ¼ 3) 44,49,51 Incentive program plus prescription program (n ¼ 3) 34,39,48 Incentive program plus personalized nutrition education plus path-to-purchase marketing (n ¼ 1) 46 ...
... The categories found to be most effective at producing healthier shopping behaviors and purchases were signage, displays and nutrition labels (n ¼ 9) 146,148,150,153,155,157,162,163,166 ; gr o up classes/store tours (n ¼ 5) 67, 184,186,187,189 ; and a combination of incentive program, path-to-purchase marketing and personalized nutrition education (n ¼ 21). 40,42,45,47,81,110,183,197,[201][202][203][204][205][206][207][208][209][210][211][212][213] Eating Habits. Sixty-five studies looked at behavior change, focusing on improvement in eating habits, such as inclusion of more fruits and vegetables in the diet or the consumption of fewer sugar-sweetened beverages. ...
Article
As nutrition-related diseases contribute to rising health care costs, food retail settings are providing a unique opportunity for registered dietitian nutritionists (RDNs) to address the nutritional needs of consumers. Food as Medicine interventions play a role in preventing and/or managing many chronic conditions that drive health care costs. The objective of this scoping review was to identify and characterize literature examining Food as Medicine interventions within food retail settings and across consumer demographics. An electronic literature search of 8 databases identified 11,404 relevant articles. Results from the searches were screened against inclusion criteria, and intervention effectiveness was assessed for the following outcomes: improvement in health outcomes and cost-effectiveness. One-hundred and eighty-six papers and 25 systematic reviews met inclusion criteria. Five categories surfaced as single interventions: prescription programs, incentive programs, medically tailored nutrition, path-to-purchase marketing, and personalized nutrition education. Multiple combinations of intervention categories, reporting of health outcomes (nutritional quality of shopping purchases, eating habits, biometric measures), and cost-effectiveness (store sales, health care dollar savings) also emerged. The intervention categories that produced both improved health outcomes and cost-effectiveness included a combination of incentive programs, personalized nutrition education, and path-to-purchase marketing. Food as Medicine interventions in the food retail setting can aid consumers in navigating health through diet and nutrition by encompassing the following strategic focus areas: promotion of health and well-being, managing chronic disease, and improving food security. Food retailers should consider the target population and desired focus areas and should engage registered dietitian nutritionists when developing Food as Medicine interventions.
... The NLS programs focused on small, targeted changes within a food group to meet nutritional guidelines. A series of randomized control field studies with NLS demonstrated that NLS users decreased fat and increased fiber, fruits, and vegetables in their supermarket food purchases [104] [105] [106] [107] and could maintain some of these changes after contact with the program ended as assessed by a system using participants' food shopping receipts [108]. Program acceptability and nutrition effects held across study participants from a range of socioeconomic groups [105] [106] [107]. ...
... A series of randomized control field studies with NLS demonstrated that NLS users decreased fat and increased fiber, fruits, and vegetables in their supermarket food purchases [104] [105] [106] [107] and could maintain some of these changes after contact with the program ended as assessed by a system using participants' food shopping receipts [108]. Program acceptability and nutrition effects held across study participants from a range of socioeconomic groups [105] [106] [107]. ...
Article
A major focus of Healthy People 2010 is promoting weight management and physical activity because overweight, obesity, and a sedentary lifestyle are strongly associated with risk for heart disease and stroke, diabetes, cancers, and premature death. Prevalence data and a focused review of weight management and physical activity studies point to the long-term weight gain prevention in normal weight (21-25 BMI), overweight (25-29 BMI), and even moderate obese (30-34 BMI) people as one alternative to prioritizing weight loss in health behavior interventions. This is because on a population basis annual weight gain is small (approximately 0.8 kg/year) and preventing weight gain appears to require only an energy shift of about 100 cal/day either through a modest increase in physical activity and/or consuming slightly less calories to maintain an energy balance. A more dynamic use of social cognitive theory (SCT) for developing programs to maintain health behavior changes is emerging with some evidence of long-term maintenance. The high use of the Internet provides a vehicle to reach different population segments with readily accessible, SCT-tailored long-term programs. Research studies using the Internet with tailored SCT interventions have shown changes in nutrition practices, physical activity, and weight loss for up to a year. One promising approach to weight gain prevention in population segments is the development and wide spread use of longer-term Internet programs using specific principles and procedures from SCT.
... However, unless collected in conjunction with perceived or real verifiable objective data, the accuracy of self-report measures such as food frequencies has been found to seriously underestimate risk behaviors in general populations (Newell, Girgis, Sanson-Fisher, & Savolainen, 1999). Previous research has found that annotated food-shopping receipt data, collected over a period of time, can provide an objective, sensitive measure of dietary behavior of individual food shoppers Winett et al., 1991Winett et al., ,1997. Using a database of supermarket foods (Rankin et al., 1998;Winett et al., 1997), supermarket receipts can provide rich data regarding the nutritional status of individuals whose diets consist largely of foods purchased at food stores. ...
... Previous research has found that annotated food-shopping receipt data, collected over a period of time, can provide an objective, sensitive measure of dietary behavior of individual food shoppers Winett et al., 1991Winett et al., ,1997. Using a database of supermarket foods (Rankin et al., 1998;Winett et al., 1997), supermarket receipts can provide rich data regarding the nutritional status of individuals whose diets consist largely of foods purchased at food stores. For individuals who purchase a smaller proportion of foods at food stores, foodshopping receipts are less sensitive to intervention-related dietary change (Winett etal., 1991(Winett etal., ,1997. ...
Article
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A social-cognitive model of nutrition behavior (A. Bandura, 1997) was tested using structural equation modeling of data from 307 food shoppers recruited from 5 supermarkets in Southwest Virginia. The shoppers were participating in the baseline phase of an ongoing nutrition promotion program. As part of the evaluation, data were collected on the self-efficacy and outcome-expectations components of social-cognitive theory as well as on food purchases and intake. The structural analyses presented here support the social-cognitive model. Self-efficacy, physical outcome expectations, age, socioeconomic status, and number of children were important predictors of nutrition behavior among shoppers. Implications for interventions using social-cognitive variables to improve the nutritional content of food purchases and intake are discussed.
... Supermarkets are an excellent location to introduce informational [Ganapathy et al. 2011;Anderson et al. 2001;Wientt et al. 1997;Mhurchu et al. 2007] and dietary behavior [Kalnikaite et al. 2011;Mankoff et al. 2002] interventions because they are the place where most individuals in the United States make decisions and purchase their food products. An example of an informational intervention is a system where participants take pictures of items, for example, chips, which are then matched in an image database to provide product information that is overlaid on the picture of the product [Ganapathy et al. 2011]. ...
... Other informational interventions rely on shoppers stopping by a supermarket kiosk to receive nutritional information [Anderson et al. 2001;Wientt et al. 1997] and coupons to incentivize healthier choices [Mhurchu et al. 2007]. Although these systems did encourage participants to purchase healthier food, marginalized populations were less likely to use the system. ...
Article
Full-text available
Augmented reality (AR) applications have recently become popular on modern smartphones. We explore the effectiveness of this mobile AR technology in the context of grocery shopping, in particular as a means to assist shoppers in making healthier decisions as they decide which grocery products to buy. We construct an AR-assisted mobile grocery-shopping application that makes real-time, customized recommendations of healthy products to users and also highlights products to avoid for various types of health concerns, such as allergies to milk or nut products, low-sodium or low-fat diets, and general caloric intake. We have implemented a prototype of this AR-assisted mobile grocery shopping application and evaluated its effectiveness in grocery store aisles. Our application's evaluation with typical grocery shoppers demonstrates that AR overlay tagging of products reduces the search time to find healthy food items, and that coloring the tags helps to improve the user's ability to quickly and easily identify recommended products, as well as products to avoid. We have evaluated our application's functionality by analyzing the data we collected from 15 in-person actual grocery-shopping subjects and 104 online application survey participants.
... Protocols also differ in techniques to document purchases without receipts and record details about foods. Several studies trained participants to document additional details directly on the receipts (Rankin et al., 1998; Winett et al., 1997) or make detailed annotations of all purchases (French, Wall, Mitchell, Shimotsu, & Welsh, 2009) during the data collection period. These annotation techniques may produce more accurate results since information is recorded closer to the purchase occasion; although extensive annotation may decrease accuracy by increasing subject burden and awareness of healthful qualities of food (i.e. ...
... The level of nutritional analysis and classification of food groups represent the main differences in data coding. Other studies utilized nutritional databases (Rankin et al., 1998; Ransley et al., 2001; Winett et al., 1997) to estimate energy, macronutrient, and fiber in food purchases. While analyzing foods by nutrients may provide more precise research outcomes, analyzing foods by categories produce results that can be applied more readily to individual dietary decisions and allow investigation of the association with intake of food groups. ...
Article
Rates of childhood obesity and comorbidities have been escalating steadily over the past three decades. Children’s food environment may promote excessive consumption of energy-dense food. This concurrent mixed-methods dissertation examined the relationship between physical home food environment (availability and accessibility) and body mass index (BMI) of middle school children within the contextual process of their food choices. Sixty-five children from a U.S. public middle school were enrolled. BMI z-scores were calculated based on measured weight and height, and derived against national reference data for standardization. Food store receipt and purchase log data were collected as a measure of home food availability. Home food accessibility, dietary intake, and other BMI covariates were measured via questionnaires and recalls. Hierarchical multiple regression analyses were conducted (n=58 participants). Semi-structured interviews were conducted with a sub-sample of children (n=47 participants) to explore factors that affect their food choices in the home. A data-driven content analysis was performed. Quantitative and qualitative data were integrated in analysis by exploring the differences in qualitative data by overweight status and in the interpretation of the results. Home food availability and accessibility were not significantly associated with BMI z-scores. However, dietary intake of fruits, low-fat dairy, and sugar-sweetened beverages were correlated with their availability in the home. Qualitative data revealed that children’s food choice in the home was a dynamic process involving three main interacting components – the child, parent, and food – embedded in the context of time. Overweight children emphasized weight concerns and nutritional aspects of foods, such as calories, in describing their food choices. Compared to healthy weight children, overweight children also expressed greater emotion in their preferences for and awareness of higher-energy foods in their homes. The inconsistency between the desire to lose weight and preferences for and awareness of higher-energy foods along with the significant associations between availability and intake support a focus on physical home environment within family-based obesity interventions. Future research should test the relationship between the home food environment, dietary intake, and BMI with larger cross-sectional or prospective studies and explore children’s process of food choice in other settings.
... Two of the trials examined the effectiveness of the Nutrition for a Lifetime System (NLS) web-based program, with comparable results (29,38). The NLS is an automated computerized intervention based in supermarkets and provided PN feedback on personal behavior change goals. ...
... Participants in the PN NLS intervention completed the NLS computer program weekly and control group participants did not receive dietary advice. Participants in the PN NLS group significantly reduced their fat (3.2%) intake and increased their intakes of fiber (1.2 g/1,000 kcal) and F&V (0.29 g/1,000 kcal) compared to control group participants (P < 0.001) (38). Results of the EU Food4Me 6-month web-based dietary intervention study found that web-based PN, regardless of the level of personalization, was more effective at improving healthy eating, when compared to controls that received standardized web-based dietary advice (16). ...
Article
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Prevention strategies for non-communicable diseases (NCDs) are a global priority as it has been estimated that NCDs will account for around 73% of worldwide mortality by the year 2020. The adoption of diets that are low in saturated fat, free sugars, and red and processed meats and higher in unsaturated fats, wholegrains, fruit, and vegetables have been shown to reduce the risk of NCDs. With increasing internet use, several nutrition interventions are now being conducted online as well as face-to-face, however it is unclear which delivery method is most effective. Although a consumer preference toward face-to-face dietary advice delivery has been identified previously, interest in delivering web-based dietary advice, and in particular personalized nutrition (PN), has been rising, as internet delivery may be less costly and more scalable. This review compares published face-to-face and web-based dietary interventions to give insight into which dietary method might be more effective for PN. In total, 19 peer-reviewed randomized controlled trials were identified for inclusion in the review. The majority of face-to-face nutrition interventions were successful at facilitating dietary change. Results from web-based nutrition interventions suggested that personalized web-based nutrition interventions may be successful at inducing short-term dietary change compared to standardized dietary interventions, however, minimal evidence of long-term impact has been found across both delivery methods. Results of a trial that compared face-to-face with web-based diet intervention found significantly greater dietary changes in the face-to-face group compared to web-based and control groups. Further controlled comparative studies and cost-benefit analysis are needed to assess whether web-based methods can be used in place of face-to-face interventions for achieving dietary change.
... Computers are useful tools to tailor messages for large groups of people at low costs [25]. Research has reported that computer tailoring has a positive effect on PA2627282930, fruit and vegetable consumption [26,3132333435363738 and saturated fat intake [39,40], also compared to generic information on changing these behaviors [27,33,37,40,41]. MI is defined as "a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence" (p. ...
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A large proportion of adults fail to meet public health guidelines for physical activity as well as fruit, vegetable and fat intake. Interventions are needed to improve these health behaviors. Both computer tailoring and motivational interviewing have shown themselves to be promising techniques for health behavior change. The Vitalum project aims to compare the efficacy of these techniques in improving the health behaviors of adults aged 45-70. This paper describes the design of the Vitalum study. Dutch general medical practices (N = 23) were recruited via a registration network or by personal invitation. The participants were then enrolled through these general practices using an invitational letter. They (n = 2,881) received a written baseline questionnaire to assess health behaviors, and potential psychosocial and socio-demographic behavioral determinants. A power analysis indicated that 1,600 participants who were failing to meet the guidelines for physical activity and either fruit or vegetable consumption were needed. Eligible participants were stratified based on hypertension status and randomized into one of four intervention groups: tailored print communication, telephone motivational interviewing, combined, and control. The first two groups either received four letters or took part in four interviews, whereas the combined group received two letters and took part in two interviews in turns at 5, 13, 30 and 43 weeks after returning the baseline questionnaire. Each letter and interview focused on physical activity or nutrition behavior. The participants also took part in a telephone survey 25 weeks after baseline to gather new information for tailoring. There were two follow-up questionnaires, at 47 and 73 weeks after baseline, to measure short- and long-term effects. The control group received a tailored letter after the last posttest. The process, efficacy and cost-effectiveness of the interventions will be examined by means of multilevel mixed regression, cost-effectiveness analyses and process evaluation. The Vitalum study simultaneously evaluates the efficacy of tailored print communication and telephone motivational interviewing, and their combined use for multiple behaviors and people with different motivational stages and education levels. The results can be used by policymakers to contribute to evidence-based prevention of chronic diseases. Dutch Trial Register NTR1068.
... Using interactive computer technology, Winett et al. (1991) reported decreased purchase of high fat foods and increased purchase of high Ðber foods, as measured by cash register receipts, among consumers who used an instructional video program as compared with a control group. However, even an updated version of the program, reduced from 10È20 minutes to 3È5 minutes, was considered ""too longÏÏ by busy shoppers (Winett et al., 1997). Dougherty et al. (1990) produced and evaluated the e †ect of a series of four videotapes on knowledge and behavior of supermarket shoppers in four stores. ...
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Consumers make an estimated 70% of their food purchase decisions as they shop. Effective presentation of information about healthier food selections at the point-of-purchase should have an impact on their decisions. This study was designed to evaluate the effectiveness of two audio formats on knowledge, attitudes, and beliefs about fruits and vegetables and on intake of these foods. Participants identified as "regular shoppers" (n = 374) in three intervention stores were recruited as they entered. They provided baseline demographic data, answered questions about their knowledge and beliefs about fruits and vegetables, and completed a checklist to assess fruit and vegetable intake. They were given two one-hour audiotapes and asked to play them within the next four weeks. In-store public service announcements (PSAs) with information about fruits and vegetables were rotated every 30 minutes for four weeks. A control group (n = 378), recruited in three other stores matched by demographic characteristics, provided the same information. They received an audiotape with stress reduction information. At posttest, the original series of questionnaires were readministered in telephone interviews with 87.7% of the original intervention group and 93.7% of the original control group. Knowledge scores in the intervention group increased significantly over baseline and as compared with the control group. Self-reported fruit and vegetable intake increased significantly in both groups, perhaps in part because of a seasonal effect. The increase from baseline was significantly higher in the intervention group and compared with controls. These findings support the further exploration of the use of audiotapes in nutrition education interventions.
... Similarly, telephone linked care systems provide strong recommendations on what to eat, how to get exercise, and how to take medications. Both types of systems have proven effective in clinical trials [12], [13]. Notwithstanding the results of these studies, however, most people feel strongly that a computer making suggestions about what they should be doing is not a computer system they wish to be using over a long period of time. ...
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Healthcare systems in developed countries are experiencing severe financial stress as age demographics shift upward, leading to a larger percentage of older adults needing care. One way to potentially reduce or slow spiraling medical costs is to use technology, not only to cure sickness, but also to promote wellness throughout all stages of life, thereby avoiding or deferring expensive medical treatments. Ubiquitous computing and context-aware algorithms offer a new healthcare opportunity and a new set of research challenges: exploiting emerging consumer electronic devices to motivate healthy behavior as people age by presenting "just-in-time" information at points of decision and behavior
... Abdullah et al. 23 explain that Japanese people has always consumed fruit for their diet as well as dessert and snack which the average of 45.2 kg capita -1 since 1965. Fruit being selected by people to meet their necessary due to it provides many advantages such as it was significantly reduced fat and increased fiber for nutrition in a human body lifetime system, compared with other part of plant 24 . It can be easily found and also its availability as well as distribution almost in the area. ...
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Rahawarin YY. 2017. Non-timber forest products extracted activities of the upstream Mamberamo basin’s traditional communities of West Papua, Indonesia. Asian J For 1: 23-26. The aim of this study is to find utilization activities of extracting nontimber forest products by local communities on the upstream part of Mamberamo Basin. Survey, observation and semi-structural interview were taken to generate data and information. The result showed that the local communities extracted several of non-timber forest products over the course of their generations to fulfill basic daily necessities. There were several types of non-timber forest products that have been used by local communities either from plants wild animals that living across different types of forest. These activities were lasted for generations so that people called it as a traditional conservation. They are still exist recently and believed to maintain the long-lasting of non timber forest products continuity to keep the availability of traditional food sources for the daily needs over generations.
... Computers are useful tools to tailor messages for large groups of people at low costs [25]. Research has reported that computer tailoring has a positive effect on PA [26][27][28][29][30], fruit and vegetable consumption [26,[31][32][33][34][35][36][37][38] and saturated fat intake [39,40], also compared to generic information on changing these behaviors [27,33,37,40,41]. ...
... Abdullah et al. 23 explain that Japanese people has always consumed fruit for their diet as well as dessert and snack which the average of 45.2 kg capita -1 since 1965. Fruit being selected by people to meet their necessary due to it provides many advantages such as it was significantly reduced fat and increased fiber for nutrition in a human body lifetime system, compared with other part of plant 24 . It can be easily found and also its availability as well as distribution almost in the area. ...
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The aim of this study is to identify the non-woody plants that are utilized by local communities in Papua Island, Indonesia for food and beverages. Results of the study will provide baseline information for the local Government to develop management strategies and policies for the conservation of the forest resources, including the useful plants. The data was gathered through observation, interviews and focused group discussion with people which is strongly influenced in the communities. Data gathered included indigenous knowledge of plant use and others indigenous practices and perceptions pertaining to the use and management of the forest. There are 90 plant species belonging to 38 families that where identified that are used by the local communities primarily for food and beverages. Of which, 21 species that belong to Arecaceae are frequently used by the local communities. The plant parts utilized are usually the fruits and leaves.
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Purpose of Review Update the state of evidence on the effectiveness of retail food environment interventions in influencing diet and explore the underlying role of public policy, through a systematic review of population-level interventions to promote health in the retail food environment, including community and consumer environments. Diet-related outcomes included purchasing, dietary intakes, diet quality, and health including weight. We coded studies for enabling public policy levers underpinning the intervention, using two widely used conceptual frameworks. Recent Findings Of 86 articles (1974–2018), the majority (58 articles, 67%) showed at least one positive effect on diet. Thirteen articles (15%) discussed natural experiments, 27 articles (31%) used a design involving comparison groups including 23 articles (27%) specifically describing randomized controlled trials, and 46 (53%) were quasi-experimental (cross-sectional) evaluations. Across the “4Ps” of marketing (product, promotion, placement, and price), promotion comprised the greatest proportion of intervention strategies, especially in earlier literature (pre-2008). Few studies combined geographic access interventions with 4P strategies, and few used robust dietary intake assessments. Behavior change communication remains an intervention mainstay, but recent work has also incorporated environmental and social planning, and fiscal strategies. More recent interventions were multi-component. Summary The retail food environment intervention literature continues to grow and has become more robust overall, with clearer evidence of the effect of interventions on diet-related outcomes, including consumer purchasing, dietary intakes, and health. There is still much scope for development in the field. Attention to enabling public policy could help to strengthen intervention implementation and evaluation in the retail food environment.
Article
The use of computers to promote healthy behavior is increasing. To evaluate the efficacy of these computer-delivered interventions, we conducted a meta-analysis of the published literature. Studies examining health domains related to the leading health indicators outlined in Healthy People 2010 were selected. Data from 75 randomized controlled trials, published between 1988 and 2007, with 35,685 participants and 82 separate interventions were included. All studies were coded independently by two raters for study and participant characteristics, design and methodology, and intervention content. We calculated weighted mean effect sizes for theoretically-meaningful psychosocial and behavioral outcomes; moderator analyses determined the relation between study characteristics and the magnitude of effect sizes for heterogeneous outcomes. Compared with controls, participants who received a computer-delivered intervention improved several hypothesized antecedents of health behavior (knowledge, attitudes, intentions); intervention recipients also improved health behaviors (nutrition, tobacco use, substance use, safer sexual behavior, binge/purge behaviors) and general health maintenance. Several sample, study and intervention characteristics moderated the psychosocial and behavioral outcomes. Computer-delivered interventions can lead to improved behavioral health outcomes at first post-intervention assessment. Interventions evaluating outcomes at extended assessment periods are needed to evaluate the longer-term efficacy of computer-delivered interventions.
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To pilot the design and methodology for a large randomised controlled trial (RCT) of two interventions to promote healthier food purchasing: culturally appropriate nutrition education and price discounts. A 12-week, single-blind, pilot RCT. Effects on food purchases were measured using individualised electronic shopping data ('Shop 'N Go' system). Partial data were also collected on food expenditure at other (non-supermarket) retail outlets. A supermarket in Wellington, New Zealand. Eligible customers were those who were the main household shoppers, shopped mainly at the participating store, and were registered to use the Shop 'N Go system. Ninety-seven supermarket customers (72% women; age 40 +/- 9.6 years, mean +/- standard deviation) were randomised to one of four intervention groups: price discounts, nutrition education, a combination of price discounts and nutrition education, or control (no intervention). There was a 98% follow-up rate of participants, with 85% of all reported supermarket purchases being captured via the electronic data collection system. The pilot did, however, demonstrate difficulty recruiting Maori, Pacific and low-income shoppers using the electronic register and mail-out. This pilot study showed that electronic sales data capture is a viable way to measure effects of study interventions on food purchases in supermarkets, and points to the feasibility of conducting a large-scale RCT to evaluate the effectiveness of price discounts and nutrition education. Recruitment strategies will, however, need to be modified for the main trial in order to ensure inclusion of all ethnic and socio-economic groups.
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Although computer-tailored promotion of dietary change and physical activity has been identified as a promising intervention strategy, there is a need for a more systematic evaluation of the evidence. This study systematically reviews the scientific literature on computer-tailored physical activity and nutrition education. Intervention studies published from 1965 up to September 2004 were identified through a structured search in PubMed, PsycInfo, and Web of Science and an examination of reference lists of relevant publications. Studies were included that applied a pretest-posttest randomized-controlled trial design, were aimed at primary prevention among adults, used computer-tailored interventions to change physical activity and dietary behaviors, and were published in English. The search resulted in 30 publications-11 on physical activity behaviors and 26 on nutrition behaviors, some studies investigated multiple behaviors. Three of 11 of the physical activity studies and 20 of 26 of the nutrition studies found significant effects of the tailored interventions. The evidence was most consistent for tailored interventions on fat reduction. Overall, there seems to be potential for the application of computer tailoring for promoting healthy diets, but more research is needed to test computer-tailored interventions against other state-of-the-art intervention techniques and to identify the mechanisms underlying successful computer tailoring.
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The public are being encouraged by Government, at a national level, to take a greater role in the management of their health and healthcare but information to support this is not always accessible to black and ethnic minority group members who do not speak or read English. This study looks at the feasibility of providing health-related information in a multilanguage format through a touchscreen kiosk. Three touchscreen kiosks were programmed with information on 10 health topics translated into five languages: Chinese, Bengali, Gujarati, Urdu and Mirpuri Punjabi. Information was provided orally and in written format. Over an 18-month period the touchscreens were rotated between settings including health centres and libraries, located in deprived areas of Leicester, Sheffield and Nottingham. Information was logged on each individual user with respect to language used, topic selected, age group and gender of user. A number of users were invited to complete a short questionnaire about their use and ease of use of the touchscreen. Touchscreens were accessed by 2,456 people across all ages, 53% of whom were male. Urdu and Gujarati were the most frequently accessed languages (37 and 38%, respectively) and Bengali used least (9%). There was some variation in use by setting. Most of the 508 people questioned who had used the touchscreen found it easy to use. Ease of use was related to home computer use and to being younger in age. The five most popular topics accessed by 12% or more users were stress, diabetes, blood pressure, healthy eating and exercise. Topic choice varied by language used by males but not by females. Touchscreens providing health information in ethnic minority languages can be successfully accessed by black and ethnic minority groups, particularly those living in deprived areas. Touchscreens proved acceptable to, and were used by, the targeted audience.
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Background: Effectiveness of using visual approaches in health education and its influential factors were still in debate. Objectives: To assess the effects of visualized nutrition education on dietary knowledge and behavioral changes, and factors influencing them. Methods: A comprehensive search of PubMed, EMBASE, Scopus and Cochrane Library was conducted. Eligible studies were trials assessed effects of visualized nutrition education on dietary knowledge or behavior changes, compared with non-visualized or no education group. Results: Fourteen studies (n = 7,259) were qualitatively analyzed and 7 of them were included in the meta-analysis. We found a higher fiber intake in both short term (1.59g/1000kcals, 95%CI 0.90-2.27) and long term (1.36g/1000kcals, 95%CI 0.64-2.09). A marginal advantage was shown in short-term fruits and vegetables consumption (F&V consumption) (standardized mean difference (SMD) = 0.08, 95%CI -0.00-0.16). The education effects were more pronounced when education was delivered in series (SMDF&V consumption = 0.09, 95%CI 0.00-0.17), avoiding loss-framing (SMDFat intake = 0.31, 95%CI 0.10-0.51) and video modeling (SMDF&V consumption = 0.23, 95%CI 0.03-0.43), with short length plus cultural adaptation. Conclusions: Visualized nutrition education was overall promising in improving dietary behaviors. Delivering in series, short in length, with cultural adaptation were features tended to enlarge the benefits of visualized education while loss-framing and video modeling might be avoided.
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Web-based diabetes management can be used to provide frequent interactions between patients and providers and thus result in improved glycemic control. In a single-center, prospective feasibility study, 16 poorly controlled patients with either type 1 or 2 diabetes mellitus were enrolled to assess the impact of using MyCareTeam, a web-based diabetes management application, for diabetes management. Patients were asked to transfer their blood glucose data electronically, maintain exercise logs, and communicate with their provider via MyCareTeam. The provider gave clinical interventions to optimize blood glucose control and provided feedback via MyCareTeam. Diabetes, nutrition, and exercise information was also available via MyCareTeam. A significant reduction of over 2.22% points in hemoglobin A1C was seen for the total patient population. Differences between moderate/heavy users (n = 8) versus light/never users (n = 8) of MyCareTeam were evaluated for intergroup differences based upon utilization. Moderate/heavy users had a significant 6-month A1C reduction of 3.15 percentage points compared with a reduction of 1.28 percentage points in light/never users. Other secondary end points were improved as well, including systolic blood pressure, diastolic blood pressure, total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides. However, as expected, body mass index levels increased because of aggressive diabetes management with insulin therapy. These results demonstrate a significant treatment effect from the MyCareTeam application. A larger randomized control trial is under way at the Boston Veterans Administration Healthcare System. If these results are confirmed as expected, then web-based diabetes management may prove to be the link to achieving target American Diabetes Association glycemic goals in patients with poorly controlled diabetes.
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The Internet is a promising new tool for disseminating cancer prevention information. Barriers to full implementation include disparities in access and skill and availability of information relevant at the local level. A nutrition education Web site to promote fruit and vegetable intake is being produced for a tri-ethnic adult population in Colorado and New Mexico. Development is guided by findings from formative research including focus groups with local residents, a survey on computer and Internet use with 200 adults in 1998, an assessment of public access computer sites, and in-depth discussion with local community computer skills trainers.
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Rapid increases in access to the Internet have made it a viable mode for public health intervention. No controlled studies have evaluated this resource for weight loss. To determine whether a structured Internet behavioral weight loss program produces greater initial weight loss and changes in waist circumference than a weight loss education Web site. Randomized, controlled trial conducted from April to December 1999. Ninety-one healthy, overweight adult hospital employees aged 18 to 60 years with a body mass index of 25 to 36 kg/m(2). Analyses were performed for the 65 who had complete follow-up data. Participants were randomly assigned to a 6-month weight loss program of either Internet education (education; n = 32 with complete data) or Internet behavior therapy (behavior therapy; n = 33 with complete data). All participants were given 1 face-to-face group weight loss session and access to a Web site with organized links to Internet weight loss resources. Participants in the behavior therapy group received additional behavioral procedures, including a sequence of 24 weekly behavioral lessons via e-mail, weekly online submission of self-monitoring diaries with individualized therapist feedback via e-mail, and an online bulletin board. Body weight and waist circumference, measured at 0, 3, and 6 months, compared the 2 intervention groups. Repeated-measures analyses showed that the behavior therapy group lost more weight than the education group (P =.005). The behavior therapy group lost a mean (SD) of 4.0 (2.8) kg by 3 months and 4.1 (4.5) kg by 6 months. Weight loss in the education group was 1.7 (2.7) kg at 3 months and 1.6 (3.3) kg by 6 months. More participants in the behavior therapy than education group achieved the 5% weight loss goal (45% vs 22%; P =.05) by 6 months. Changes in waist circumference were also greater in the behavior therapy group than in the education group at both 3 months (P =.001) and 6 months (P =.005). Participants who were given a structured behavioral treatment program with weekly contact and individualized feedback had better weight loss compared with those given links to educational Web sites. Thus, the Internet and e-mail appear to be viable methods for delivery of structured behavioral weight loss programs.
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Introduction The supermarket is increasingly recognised as a key environment to promote healthy eating. No previous reviews have focused specifically on the effectiveness of interventions that target the in-store supermarket environment for improving the healthiness of population food purchases. Methods Systematic review of supermarket-based interventions related to nutrition. Interventions were included if they related to the type of products available for sale, promotion or consumer education and/or product placement. Interventions related to price and on-pack labelling were excluded. Outcomes included food purchasing, food consumption or body weight. Study quality was assessed using the Effective Public Health Practice Project quality assessment tool. Results Of 50 included studies, the majority were conducted in the USA (74 %), with 33 % published in the last 3 years. Seventy percent of studies were rated as moderate (n = 11) or high (n= 24) quality. Positive effects were observed in 35 studies (70 %). Of the 15 studies that reported null or negative findings, most (n = 12) did not have a strong study design, large sample size or duration longer than 1 month. Conclusions Most high-quality studies targeting the supermarket food environment reported improvements in the healthiness of consumer purchases in response to the intervention. Although it is difficult to identify specific intervention options that are likely to be most effective and sustainable in this setting, shelf labelling (particularly using nutrition summary scores) stands out as being particularly promising.
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The dietary guidelines of most developed countries include one that promotes the intake of fruits and vegetables. In most of these countries, fruit and vegetable intakes are well below the recommendations made by the relevant health bodies, and in recent years, several intervention initiatives have been undertaken to address this issue. To date there has been limited success. This article describes current fruit and vegetable intakes in Australia, a country with an abundant and relatively inexpensive supply of these foods, and attempts to understand why intakes still fall below recommendations using research into our knowledge of the psychosocial determinants of fruit and vegetable intake and how this might be limiting the effectiveness of intervention strategies.
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Little is known about how much smartphone apps for weight control adhere to evidence-informed practices. The aim of this study was to review and summarize the content of available weight control apps. Information on content, user rating, and price was extracted from iTunes on September 25, 2009. Apps (n = 204) were coded for adherence to 13 evidence-informed practices for weight control. Latent class analysis was used to identify subgroups of apps based on endorsement practices. Only a small percentage of apps had five or more of the 13 practices (15%). Latent class analysis revealed three main types of apps: diet, physical activity, and weight journals (19%); dietary advice and journals (34%); and weight trackers (46%). User ratings were not associated with apps from these three classes. Many apps have insufficient evidence-informed content. Research is needed that seeks to develop, improve, and evaluate these apps.
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Nutrition has a big impact on health, including major dis- eases such as heart disease, osteoporosis, and cancer. This paper presents an application designed to help people keep track of the nutrional content of foods they have eaten. Our work uses shopping receipts to generate suggestions about healthier food items that could help to supplement missing nutrients. We present our system design: a capture and access application that, based on shopping receipt data, provides access to am- biguous suggestions for more nutritious purchases. We also report re- sults from one formative user study suggesting that receipts may provide enough information to extend our work by also estimating what people are actually eating, as opposed to simply what they are purchasing.
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Epidemiological analyses conclude that the major contributors to all-cause premature mortality and morbidity are smoking, alcohol abuse, inappropriate diet, and a sedentary lifestyle. Efforts to modify these health behaviors in populations with community and worksite interventions, although initially promising, have had difficulty in sustaining health-behavior changes. More intensive, theoretically based interventions targeted to at-risk groups and delivered in smaller social units, such as churches and other religious organizations, have been recommended. An intervention based on social cognitive theory that entails integrating self-regulatory procedures with social and environmental supports in rural churches serving people from lower socioeconomic groups is described in detail.
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Dietary behavior and attitude play major roles in the worldwide prevalence of obesity, as weight is gained when energy intake exceeds energy expenditure. Although research has focused on designing technological interventions for healthy eating behavior, recent reviews have identified a gap in the knowledge base regarding the variables/determinants of healthy eating and the interactions between them. We developed a model of some determinants and their impact on healthy eating as a basis for designing technological interventions to promote healthy eating behavior within a target community. The main goal of this work is to understand how people adopt a healthy eating attitude, the variables influencing such attitudes, the interactions between these variables, and the degree of influence each variable exerts on healthy eating attitudes. We use fast food-related eating behavior as our case study. Our model shows that weight concern, nutrition knowledge, concern for diseases, social influence, and food choice motives predicts 65% of the variance in healthy eating attitudes, showing the suitability of the model for use in predicting healthy eating attitude. This result will inform decisions on the most effective persuasive strategy for designing interventions to promote healthy eating behavior.
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This preliminary study assessed the efficacy of a WWW-based set of nutrition modules that served as an adjunct to a basic didactic health curriculum for 10 th grade girls in a rural high school in a medically underserved area. Through assessments on target areas and foods (eating three meals per day, consuming five servings of fruits and vegetables, increasing breads and cereals, decreasing high fat dairy, decreasing high fat snacks, decreasing regular sodas), the six module system provided goals and strategies and personalized feedback on progress. A comparison of girls in one class using the modules compared to girls in another health class not using the system on a measure similar to the food frequency questionnaire showed that use of the modules was associated with appreciable change in all areas except soda consumption. Methods to expand the use of www-based health behavior programs concurrent with future computer and Internet access were discussed.
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Objective: Information about healthy and unhealthy nutrients is increasingly conveyed at the point of purchase. Many studies have investigated the effects of product health information on attitudes and intentions, but the empirical evidence becomes sketchier when the focus of research is actual purchase behaviour. The present paper provides an overview of empirical evidence on the effectiveness of product health information for food products at the point of purchase. Design: A systematic literature review was conducted. Setting: Only studies were included that assessed the effect of product health information at the point of purchase on actual purchase behaviour, using data provided by stores' sales records or obtained by investigating customer receipts as the primary outcome measure. Subjects: The included studies' target group comprised supermarket clientele. Results: Several studies found no significant effects of product health information on actual purchase behaviour. Interventions were more likely to be effective when they lasted for a longer time, when they included additional intervention components, and when they targeted the absence of unhealthy nutrients instead of or in addition to the presence of healthy nutrients. Conclusions: No strong evidence for the effectiveness of product health information was found. The effect of intervention duration, additional promotional activities and targeting of healthy v. unhealthy nutrients should be closely examined in future studies.
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This study reports the results of one effort to help supermarket shoppers alter food purchases to make purchases (and meals) that are lower in fat and higher in fiber. A prototype interactive information system using instructional video programs, feedback on purchases with specific goals for change, weekly programs, and the ability to track user interactions and intended purchases was evaluated. The major dependent measure was users' actual food purchases as derived from participants' highly detailed supermarket receipts. After a 5- to 7-week baseline phase, participants were randomly assigned to an experimental or control condition for the 7- to 8-week intervention phase. A follow-up phase began 5 to 8 weeks after participants completed the intervention and discontinued use of the system. The results indicated that experimental participants, when compared to control participants, decreased high fat purchases and increased high fiber purchases during intervention, with evidence for some maintenance of effect in follow-up. Plans for increasing the use and impact of the system are discussed.
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The National Cancer Institute (NCI) believes that the potential for dietary changes to reduce the risk of cancer is considerable and that the existing scientific data provide evidence that is sufficiently consistent to warrant prudent interim dietary guidelines that will promote good health and reduce the risk of some types of cancer. Six interim dietary guidelines and their scientific rationale are discussed herein. The evidence presented for the scientific rationale is based on the 1982 National Academy of Sciences Committee report Diet, Nutrition and Cancer and NCI's own scientific reviews that link long-term dietary patterns with cancer risk. These guidelines to the American public are consistent with other dietary recommendations from the US departments of Agriculture and Health and Human Services, the American Cancer Society, and the American Heart Association.
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There is a disquieting sense that many theoretically based health behavior change programs have been only minimally effective. Part of the problem may be that most current theories have considerable overlap, primarily focus on intraindividual and other individual-level variables, and tend to neglect the environment and issues related to program implementation. A framework is developed for health promotion and disease prevention programs that makes use of epidemiological and health indicator data and Healthy People 2000 goals to prioritize efforts, provides a schema to formulate programs on the basis of timing (prevention) and level of intervention, and addresses the marketing approach to target and implement programs. The framework integrates current theories to guide marketing and phases of research.
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This article discusses risk behaviors, seemingly voluntary actions of individuals that have adverse health consequences. The central theme is to examine these behaviors from two contrasting perspectives, that of the individual and that of the population as a whole. It is argued that distinguishing between individual and population views is important for understanding and interpreting health risk data, for developing conceptual and theoretical models for explaining these behaviors, and for devising intervention strategies to modify them. It is argued that an appreciation of both the individual and the population perspectives is important to developing effective action strategies for reducing these behaviors as public health problems.
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Intervention efficacy can be increased when the treatment is maximally matched to the needs of the client. One means of achieving such matching is through use of an expert system, a computer-based decision-making system designed to utilize client information to produce unique, matched information and interventions. An expert system can combine the individual matching possible in a clinic-based intervention and the low cost associated with a public health approach. This paper begins by discussing several alternative implementations of the expert system approach within the general context of communication theory. Second, the theoretical model and related empirical evidence which form the basis of the expert system is described briefly. Third, the details of a computer-driven, expert system intervention specifically developed for smoking cessation is described. Finally, empirical results from a study comparing the expert system intervention to three alternative interventions for smoking cessation are presented. In general, the expert system approach can provide a cost effective, viable, and efficacious means of intervening in a specific problem behavior area. Implications and potential areas of development are discussed.
Nutrient values of American foods in common units Social foundations of thought and action: A social cognitive theory
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Risk behaviors and health: Contrasting individual and population perspectives
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A framework for health promotion and disease prevention
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Nutrition promotion and dietary change: Framework to meet Year 2000 goals
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