Karla Shelnutt

The Effects of Young Adults Eating and Active for Health (YEAH): A Theory-Based Web-Delivered Intervention

OBJECTIVE To assess the effectiveness of a tailored theory-based, Web-delivered intervention (Young Adults Eating and Active for Health) developed using community-based participatory research process. DESIGN A 15-month (10-week intensive intervention with a 12-month follow-up) randomized, controlled trial delivered via Internet and e-mail. SETTING Thirteen college campuses. PARTICIPANTS A total of 1,639 college students. INTERVENTION Twenty-one mini-educational lessons and e-mail messages (called nudges) developed with the non-diet approach and focusing on eating behavior, physical activity, stress management, and healthy weight management. Nudges were short, frequent, entertaining, and stage-tailored to each behavior, and reinforced lesson content. MAIN OUTCOME MEASURE All participants were assessed at baseline, postintervention (3 months from baseline), and follow-up (15 months from baseline) for primary outcomes of weight, body mass index (BMI), fruit and vegetable intake (FVI), physical activity (PA), and perceived stress; and secondary outcomes of waist circumference, percent dietary fat, energy from sugar-sweetened beverages, servings of whole grains, self-instruction and regulation for mealtime behavior, hours of sleep, and stage of readiness for change for consuming 5 cups of FVI, completing 150 minutes of PA/wk, and managing stress on most days of the week. Demographics were collected at baseline. ANALYSIS Chi-square analysis and mixed-models repeated measures analysis were performed to determine differences between experimental and control outcomes. RESULTS There were no differences between experimental and control participants in BMI, weight, and waist circumference. There were small improvements in FVI (P = .001), vigorous PA in females (P = .05), fat intake (P = .002), self-instruction (P = .001), and regulation (P = .004) for mealtime behavior, and hours of sleep (P = .05) at postintervention, but improvements were not maintained at follow-up. At postintervention, a greater proportion of experimental participants were in the action/maintenance stages for FVI (P = .019) and PA (P = .002) than control. CONCLUSIONS AND IMPLICATIONS Young Adults Eating and Active for Health is one of the first studies to use the community-based participatory research process of PRECEDE-PROCEED to develop a non-diet approach intervention. Although there were no differences between experimental and control participants in weight change or BMI, the intervention supported positive change in behaviors that may mediate excessive weight gain, such as increasing FVI and more healthful self-regulation mealtime behaviors immediately postintervention. Additional strategies to maintain the behavior changes need to be explored.

Development of Young Adults Eating and Active for Health (YEAH) Internet-Based Intervention via a Community-Based Participatory Research Model

OBJECTIVE To develop a tailored, theory-based, Web-delivered intervention to prevent excessive weight gain in young adults using a Community-Based Participatory Research model. DESIGN Investigators from 14 universities developed the intervention and supporting administrative portal using the 4 phases of the PRECEDE model. Steering committees were composed of the target audience (aged 19-24 years) and key health/wellness personnel were formed at each institution and provided information during each phase that was used to guide development of the intervention, Project YEAH (Young Adults Eating and Active for Health). Piloting results were used to refine the curriculum and identify and avoid barriers to delivery. RESULTS Qualitative and quantitative data collected at each phase informed Project YEAH development. In Phase 1, factors of highest priority to young adults were identified. In Phase 2, environmental supports for healthful lifestyles were elucidated. In Phase 3, behavior and environmental changes considered important and changeable were identified. In Phase 4, the 10-week, theory-based, stage-tailored, interactive-learning intervention with a 10-month reinforcement period was developed. CONCLUSIONS AND IMPLICATIONS Applying the PRECEDE model with fidelity during development of Project YEAH resulted in an intervention that pilot participants found relevant and useful, gained attention, instilled confidence in the ability to apply the information, and provided a sense of satisfaction.

Recruitment lessons learned from a tailored web-based health intervention project Y.E.A.H. (young adults eating and Active for health)

Purpose – Recruiting college students for research studies can be challenging. The purpose of this paper is to describe the lessons learned in the various recruitment strategies used for enrolling college students in a theory-based, tailored, and web-delivered health intervention at 13 US universities. Design/methodology/approach – The community-based participatory research (CBPR) model was used to develop a staged-tailored, web-based, randomized control trial, focussing on eating behavior, physical activity, and stress management. Participant feedback during baseline assessments was used to evaluate recruitment strategies. Findings – Findings from this feedback suggest that traditional recruitment strategies, such as newspaper ads and flyers, may not be the best approach for recruiting college students; instead, web-based efforts proved to be a better recruitment strategy. Research limitations/implications – This project included results from 13 US universities and thus may not be generalizable: more res...

PACES: A Physical Activity Campus Environmental Supports Audit on University Campuses

Purpose. This study evaluated the policy and built and recreation environmental supports for physical activity on 13 university campuses. Design. Environmental audit survey. Setting. Thirteen U.S. universities, 2009. Subjects. University policies, recreation programs and facilities, and at least five additional buildings per campus. Measures. The Physical Activity Campus Environmental Supports Audit was developed for this study. Analysis. Analysis of variance with post hoc Tukeys B and χ2 assessed differences by institution and building type. Results. The mean obesogenic policy score was significantly lower than the desired score, ≥ 7 (p = .002), with only one campus scoring 10. The mean built environment audit score (5.4 ± 1.7) was low, with significant differences between institutions (p < .001) and only three campuses scoring above the desired score, ≥ 7. Although generally stairwells were clean and well lighted, there was a lack of signage to encourage stair use (p < .001). Overall, recreation programs (7.1 ± .7) and facilities (7.1 ± 1.2) scored well, but amenities scores were lower for satellite (2.8 ± 1.6) versus main (4.1 ± 1.8) recreation facilities (p = .04). Conclusion. On these 13 university campuses, recreation programs and facilities were supportive of healthful lifestyles for obesity prevention, but policies and the built environment were not. This physical activity environmental audit survey requires testing in a wider sample of postsecondary institutions to corroborate its utility and provide evidence to support initiatives to improve campus environments for physical activity.

The Community-based Healthy-lifestyle Intervention for Rural Preschools (CHIRP) study: Design and methods

The CHIRP study is a two-arm, pilot randomized controlled trial assessing the effectiveness of a behavioral family weight management intervention in an important and at-risk population, overweight young children, 3 to 6 years of age, and their parents from underserved rural counties. Participants will include 96 parent-child dyads living in rural counties in north central Florida. Families will be randomized to one of two conditions: (a) behavioral family based intervention or (b) a waitlist control. Child and parent participants will be assessed at baseline (month 0), post-treatment (month 4), and follow-up (month 10). Assessments and intervention sessions will be held at the Cooperative Extension office in each participating rural county. The primary outcome measure is change in child body mass index (BMI) z-score. Additional key outcome measures include child dietary intake, physical activity, and parent BMI. This study is unique because (1) it is one of the few randomized controlled trails examining a behavioral family intervention to address healthy habits and improved weight status in young overweight and obese children, (2) addresses health promotion in rural settings, and (3) examines intervention delivery in real world community settings through the Cooperative Extension Service offices. If successful, this research has potential implications for medically underserved rural communities and preventative health services for young children and their families.

Path Analysis of Campus Walkability/Bikeability and College Students’ Physical Activity Attitudes, Behaviors, and Body Mass Index:

Purpose: The purpose of this study was to assess the relationship between the walkability/bikeability of college campuses and students’ body mass index (BMI) with student physical activity (PA) attitudes and behaviors as potential mediators. Design: Cross-sectional. Setting: Thirteen university campuses. Participants: A total of 1384 student participants. Measures: Walkability/bikeability environmental score (ES): 12-item audit assessed an average of 44 path segments per campus. Students were measured for height and weight and completed online surveys. Physical activity stage of change/behavior intentions were assessed using the transtheoretical model. The Cognitive Behavioral Physical Activity Questionnaire assessed outcome expectations, self-regulation, and personal barriers. International Physical Activity Questionnaire assessed walking-, moderate-, and vigorous-intensity PA. Analysis: Descriptive statistics, zero-order correlations, and path analysis with maximum likelihood estimation. Results: The overall model fit was good with χ2 of 171.388 (df = 18), P < .001, comparative fit index value of .95, and a root mean square of approximation of .079. After controlling for gender, there was a direct negative association between walkability/bikeability ES and BMI (β = −.085) and positive association between personal barriers and BMI (β = .134). Walkability/bikeability ES was positively associated with walking-intensity PA (β = .010). Self-regulation was positively associated with moderate-intensity PA (β = .213), which, in turn, was negatively associated with BMI (β = −.057). Conclusions: The ease of walking and biking on a campus was related to college students’ walking behavior and their BMI. Students’ PA behavioral intentions were associated with moderate PA and lower BMI. These results provide evidence to focus on policies and structural supports for walkable/bikeable environments to supplement and enhance interventions encouraging individual behavior change for PA and weight management.

Preventing Breast Cancer Recurrence through a Tailored Lifestyle Intervention: The MyLIFE (My Lifestyle Intervention with Food and Exercise) Trial Rationale and Study Design

Breast cancer risk, and risk of associated co-morbidities such as cardiovascular disease, is highest among overweight or obese women with a previous history of breast cancer. The objective of this study is to test the effectiveness of a tailored nutrition, physical activity, and behavioral weight management intervention for breast cancer survivors against a widely available commercial weight management program. We hypothesize that an intervention tailored to the unique psychological, nutritional, and physical needs of breast cancer survivors will provide superior physiological and psychological benefits compared to an existing commercial program for the general population. To test our hypothesis, we initially conducted a focus group with both breast cancer survivors and oncology affiliated health care providers in order to illicit feedback to develop an intervention customized specifically to breast cancer survivors. Subsequently, in a randomized, multicenter trial, we are studying the effect of the tailored program on overweight/obese women (N=120) with a history of breast cancer (3 months to 5 years post-primary treatment) on body weight and composition, markers of systemic inflammation related to cancer and associated chronic diseases, physical activity habits, dietary intake, health-related quality of life, and program adherence and satisfaction. Assessments will be taken prior to study initiation immediately following the intervention and at 6 months post-intervention to assess long-term maintenance of weight, lifestyle behaviors, and impact on physiological markers of disease risk. This project is unique in that it addresses weight issues in a high risk, understudied population using a tailored approach.

The development and preliminary validation of the behavior, environment, and changeability survey (BECS).

OBJECTIVE To develop and test the validity of the Behavior, Environment, and Changeability Survey (BECS) for identifying the importance and changeability of nutrition, exercise, and stress management behavior and related aspects of the environment. DESIGN A cross-sectional, online survey of the BECS and selected validated instruments. SETTING Ten state universities. PARTICIPANTS A convenience sample of college students (n = 1,283), ages 18-24 years. ANALYSIS Principal component analysis was used to confirm a 6-component structure of the BECS in 2 independent samples for the purpose of cross-validation. Internal consistency was measured and construct and criterion-related analyses were conducted to test the reliability and validity of the BECS subscales. RESULTS Six components representing 34 BECS items were revealed from the original 69 items and explained 64% of the total variance. Six scales were retained, and internal consistency of each ranged from α = .82 to .93. BECS Nutrition Behavior and Nutrition Changeability scale scores were highest for participants in action/maintenance Stages of Change for fruit and vegetable intake. CONCLUSIONS AND IMPLICATIONS There is strong support for the use of the BECS when planning health programs to gain insight into behavior that young adults are willing to improve, specifically related to nutrition, exercise, and sleep.

Elements of Access: The Effects of Food Outlet Proximity, Transportation, and Realized Access on Fresh Fruit and Vegetable Consumption in Food Deserts

This study surveys 900 supplemental nutrition assistance program recipient or eligible households and 300 supplemental nutrition assistance program ineligible households in local food deserts to identify the effects of different dimensions of access on fresh fruit and vegetables (FFV) consumption. While proximity and access to one’s own car were not significant predictors of FFV consumption, realized access to nonsupermarket outlets did have a positive effect on fresh vegetable consumption. Among food insecure respondents, limited car access had a negative effect on FFV consumption. This research underlines the importance of focusing on dimensions of access other than proximity when considering interventions designed to improve nutrition and health outcomes in food deserts.

MyPyramid for Older Adults.

One of the new features of the Dietary Guidelines for Americans, 2005, is the inclusion of Key Recommendations for Specific Population Groups, including older adults. The United States Department of Agriculture’s MyPyramid miniposter provides information for healthy Americans over 2 years of age but does not target any specific age group. With the rapid aging of the United States (US) population, there is a growing need for nutrition education and supporting educational resources targeted to adults over the age of 60, especially resources that address the special nutritional needs of this diverse age group. To address this need, the authors developed an adaptation of the MyPyramid miniposter entitled MyPyramid for Older Adults (MPOA).