Iain S. Pratt

Connecting Health and Technology (CHAT): protocol of a randomized controlled trial to improve nutrition behaviours using mobile devices and tailored text messaging in young adults

BackgroundIncreasing intakes of fruits and vegetables intake, in tandem with reducing consumption of energy-dense and nutrient poor foods and beverages are dietary priorities to prevent chronic disease. Although most adults do not eat enough fruit and vegetables, teenagers and young adults tend to have the lowest intakes. Young adults typically consume a diet which is inconsistent with the dietary recommendations. Yet little is known about the best approaches to improve dietary intakes and behaviours among this group. This randomised controlled trial aims to evaluate the effectiveness of using a mobile device to assess dietary intake, provide tailored dietary feedback and text messages to motivate changes in fruit, vegetable and junk food consumption among young adults.Methods/designThe CHAT project will involve the development of the mobile device food record (MDFR), and evaluation of dietary feedback and implementation of a 6-month intervention in young adults aged 18 to 30 years. The participants will be randomly assigned to one of three groups (1) Intervention Group 1: MDFR + Text Messages + Dietary Feedback; (2) Intervention Group 2: MDFR + Dietary Feedback; (3) Control Group 3: MDFR, no feedback. All groups will undertake a 3-day dietary record using the MDFR but only the Intervention Groups 1 and 2 will receive tailored dietary feedback at baseline and at 6-months which will consist of assessment of serves of fruits, vegetables and junk food in comparison to dietary recommendations. Tailored nutrition text messages will be sent to Intervention Group 1 over the 6 months. Data will be collected at baseline and again at the 6-month completion.DiscussionThis trial will test if applications running on mobile devices have potential to assess diet, provide tailored feedback and nutrition messages as an effective way of improving fruit and vegetable consumption and reducing energy-dense nutrient poor foods in young adults. The CHAT project will assess the impact of the intervention on behavioural intention to eat a more healthful diet. This innovative approach if successful may provide a means to deliver a low cost health promotion program that has the potential to reach large groups, particularly young adults.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12612000250831

What factors are associated with excess body weight in Australian secondary school students

Objectives: To examine the prevalence of overweight and obesity in Australian secondary school students and identify factors associated with excess adiposity.

Developing cancer warning statements for alcoholic beverages

BackgroundThere is growing evidence of the increased cancer risk associated with alcohol consumption, but this is not well understood by the general public. This study investigated the acceptability among drinkers of cancer warning statements for alcoholic beverages.MethodsSix focus groups were conducted with Australian drinkers to develop a series of cancer-related warning statements for alcohol products. Eleven cancer warning statements and one general health warning statement were subsequently tested on 2,168 drinkers via an online survey. The statements varied by message frame (positive vs negative), cancer reference (general vs specific), and the way causality was communicated (‘increases risk of cancer’ vs ‘can cause cancer’).ResultsOverall, responses to the cancer statements were neutral to favorable, indicating that they are unlikely to encounter high levels of negative reaction from the community if introduced on alcoholic beverages. Females, younger respondents, and those with higher levels of education generally found the statements to be more believable, convincing, and personally relevant. Positively framed messages, those referring to specific forms of cancer, and those using ‘increases risk of cancer’ performed better than negatively framed messages, those referring to cancer in general, and those using the term ‘can cause cancer’.ConclusionCancer warning statements on alcoholic beverages constitute a potential means of increasing awareness about the relationship between alcohol consumption and cancer risk.

Using a mass media campaign to raise women's awareness of the link between alcohol and cancer: cross-sectional pre-intervention and post-intervention evaluation surveys

Objectives To evaluate the effectiveness of a population-based, statewide public health intervention designed to improve womens awareness and knowledge of the link between alcohol and cancer. Design Cross-sectional tracking surveys conducted pre-intervention and post-intervention (waves I and III of campaign). Setting Western Australia. Participants Cross-sectional samples of Western Australian women aged 25–54 years before the campaign (n=136) and immediately after wave I (n=206) and wave III (n=155) of the campaign. Intervention The ‘Alcohol and Cancer’ mass media campaign ran from May 2010 to May 2011 and consisted of three waves of paid television advertising with supporting print advertisements. Main outcome measures Campaign awareness; knowledge of drinking guidelines and the link between alcohol and cancer; intentions towards drinking. Results Prompted recognition of the campaign increased from 67% following wave I to 81% following wave III (adjusted OR (adj OR)=2.31, 95% CI 1.33 to 4.00, p=0.003). Improvements in womens knowledge that drinking alcohol on a regular basis increases cancer risk were found following wave I (adj OR=2.60, 95% CI 1.57 to 4.30, p<0.001) and wave III (adj OR=4.88, 95% CI 2.55 to 9.36, p<0.001) compared with baseline. Knowledge of the recommended number of standard drinks for low risk in the long term increased between baseline and wave I (adj OR=1.68, 95% CI 1.02 to 2.76, p=0.041), but not baseline and wave III (adj OR=1.42, 95% CI 0.84 to 2.39, p=0.191). Among women who drink alcohol, the proportion expressing intentions to reduce alcohol consumption increased significantly between baseline and wave III (adj OR=2.38, 95% CI 1.11 to 5.12, p=0.026). However, no significant reductions in recent drinking behaviour were found following the campaign. Conclusions Results indicate a population-based mass media campaign can reach the target audience and raise awareness of links between alcohol and cancer, and knowledge of drinking guidelines. However, a single campaign may be insufficient to measurably curb drinking behaviour in a culture where pro-alcohol social norms and product marketing are pervasive.

The mathematical relationship between dishware size and portion size

Portion size has increased considerably over the past few decades and one influencing factor is dishware size. Using mathematical models we investigated how dish size affects the potential energy available in a meal. Two types of plate filling - flat and conical - were modelled for a range of plate sizes and energy densities, then compared to recommended daily energy requirements from Australian guidelines. Bowl filling was also modelled. Results indicate that a small increase in dishware size can lead to a substantial increase in energy available to be consumed, particularly if food is energy dense. This reinforces the need to consider dishware size when developing strategies to prevent over-consumption.

Beliefs about bowel cancer among the target group for the National Bowel Cancer Screening Program in Australia

Objective: To assess awareness of and intentions and self‐reported participation in the National Bowel Cancer Screening Program (NBCSP) in Australia and the programs impact on knowledge of and beliefs about bowel cancer.

Population-based evaluation of the ‘LiveLighter’ healthy weight and lifestyle mass media campaign

The Western Australian (WA) ‘LiveLighter’ (LL) mass media campaign ran during June–August and September–October 2012. The principal campaign ad graphically depicts visceral fat of an overweight individual (‘why’ change message), whereas supporting ads demonstrate simple changes to increase activity and eat healthier (‘how’ to change message). Cross-sectional surveys among population samples aged 25–49 were undertaken pre-campaign (N = 2012) and following the two media waves (N = 2005 and N = 2009) in the intervention (WA) and comparison state (Victoria) to estimate the population impact of LL. Campaign awareness was 54% after the first media wave and overweight adults were more likely to recall LL and perceive it as personally relevant. Recall was also higher among parents, but equal between socio-economic groups. The ‘why’ message about health-harms of overweight rated higher than ‘how’ messages about lifestyle change, on perceived message effectiveness which is predictive of health-related intention and behaviour change. State-by-time interactions showed population-level increases in self-referent thoughts about the health-harms of overweight (P < 0.05) and physical activity intentions (P < 0.05). Endorsement of stereotypes of overweight individuals did not increase after LL aired. LL was associated with some population-level improvements in proximal and intermediate markers of campaign impact. However, sustained campaign activity will be needed to impact behaviour.

Impact of a short, culturally relevant training course on cancer knowledge and confidence in Western Australia's Aboriginal Health Professionals

Objective: To develop, deliver and evaluate a cancer education course for Indigenous Health Professionals.

A comparison of the effectiveness of an adult nutrition education program for Aboriginal and non-Aboriginal Australians

BACKGROUND Adult nutrition education is an important component of broader societal efforts to address the high prevalence of nutrition-related diseases. In Australia, Aboriginal people are a critical target group for such programs because of their substantially higher rates of these diseases. OBJECTIVE The aim of this study was to assess the relative effectiveness of an adult nutrition education program for Aboriginal and non-Aboriginal participants. METHODS Pre-and post-course evaluation data were used to assess changes in confidence in ability to buy healthy foods on a budget, nutrition knowledge, and dietary behaviours among individuals attending FOODcents nutrition education courses. The total sample of 875 Western Australians included 169 who self-identified as Aboriginal or Torres Strait Islander. RESULTS Perceptions of course usefulness were very high and comparable between Aboriginal and non-Aboriginal participants. Significantly larger improvements in confidence, nutrition knowledge, and reported consumption behaviours were evident among Aboriginal participants. CONCLUSION The findings suggest that adult nutrition education programs that address specific knowledge and skill deficits that are common among disadvantaged groups can be effective for multiple target groups, and may also assist in reducing nutrition-related inequalities.

Preferred Tone of Nutrition Text Messages for Young Adults: Focus Group Testing

Background Young adults are a particularly hard to reach group using conventional health promotion practices as they do not see nutrition messages as personally relevant to them. Text messaging (short message service, SMS) offers an innovative approach to reaching young adults to support and promote dietary behavior change. Objective The aim of this study was to develop and test tonal preferences for nutrition text messages among young adults using focus groups. Methods A total of 39 young adults aged 18-30 years residing in Perth, Western Australia participated in four focus groups. Participants briefly discussed their perception of healthy eating and their responses to messages about increasing fruit and vegetables, and reducing “junk food” and alcohol intake. They ranked their preference for 15 nutrition messages across 3 dietary behaviors (fruit and vegetables, junk food, and alcohol) with 5 different message tones (authoritative, empathetic, generation Y, solutions, and substitutions) and identified the messages most likely to persuade young adults to change their diet. A 5-point ranking of the nutrition messages was from the most likely to least likely to persuade (1-5). The focus groups were conducted by a trained facilitator and observer and were recorded. Data driven content analysis was used to explore themes. Tonal preferences and potential motivators were collated and frequencies presented. Results Participants ranked offering substitutes (29%, 11/39) and using empathy (22%, 9/39) as the most persuasive message techniques in improving diets of young adults, with low responses for Generation Y (17%, 7/39), solutions (17%, 7/39), and authoritative (15%, 6/39) tones. Females were more likely to consider substitution messages persuasive (35%, 7/20) compared with males (22%, 4/19). A greater proportion of males compared with females considered authoritative messages persuasive: (22%, 4/19) compared with (7%, 1/20). There is a strong preference for a substitution tone for fruit and vegetable messages (52%, 20/39), and no overall message tone preference for junk food and alcohol messages. Substitutions were viewed as helpful and practical. Empathy was liked as it acknowledged previous efforts. Responses to authoritative tone were mixed with some feeling guilt while others found them informative. Acceptability of the solutions depended on the behavioral change and acceptability of the solution proposed. Generation Y tone had some support for junk food and alcohol messages, and if favored, was considered casual, humorous, catchy, and motivational. Conclusions Substitutions and tone of empathy were favored as the most likely execution styles to motivate nutrition behavior change across all participants. There is no “one size fits all” with different tones preferred by individuals for different dietary behaviors. Although text messaging provides instant message delivery direct to the individual, these results demonstrate the complexity of developing motivational nutrition message for young adults. These findings reveal the importance of considering the tone and content and pretesting messages for health promotion text message interventions.