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Health Literacy is associated with Healthy Eating Index Scores and Sugar-Sweetened Beverage Intake: Findings from the Rural Lower Mississippi Delta

BACKGROUND Although health literacy has been a public health priority area for more than a decade, the relationship between health literacy and dietary quality has not been thoroughly explored. OBJECTIVE To evaluate health literacy skills in relation to Healthy Eating Index (HEI) scores and sugar-sweetened beverage (SSB) consumption while accounting for demographic variables. DESIGN Cross-sectional survey. PARTICIPANTS/SETTING A community-based proportional sample of adults residing in the rural Lower Mississippi Delta. METHODS Instruments included a validated 158-item regional food frequency questionnaire and the Newest Vital Sign (scores range 0 to 6) to assess health literacy. STATISTICAL ANALYSES PERFORMED Descriptive statistics, analysis of variance, and multivariate linear regression. RESULTS Of 376 participants, the majority were African American (67.6%), without a college degree (71.5%), and household income level <

Exploring the Theory of Planned Behavior to Explain Sugar-sweetened Beverage Consumption

20,000/year (55.0%). Most participants (73.9%) scored in the two lowest health literacy categories. The multivariate linear regression model to predict total HEI scores was significant (R(2)=0.24; F=18.8; P<0.01), such that every 1-point increase in health literacy was associated with a 1.21-point increase in HEI scores, while controlling for all other variables. Other significant predictors of HEI scores included age, sex, and Supplemental Nutrition Assistance Program participation. Health literacy also significantly predicted SSB consumption (R(2)=0.15; F=6.3; P<0.01) while accounting for demographic variables. Every 1 point in health literacy scores was associated with 34 fewer kilocalories per day from SSBs. Age was the only significant covariate in the SSB model. CONCLUSIONS Although health literacy has been linked to numerous poor health outcomes, to our knowledge this is the first investigation to establish a relationship between health literacy and HEI scores and SSB consumption. Our study suggests that understanding the causes and consequences of limited health literacy is an important factor in promoting compliance to the Dietary Guidelines for Americans.

The Thrifty Food Plan Is Not Thrifty When Labor Cost Is Considered

OBJECTIVE To describe sugar-sweetened beverage (SSB) consumption and to establish psychometric properties and utility of a Theory of Planned Behavior (TPB) instrument for SSB consumption. METHODS This cross-sectional survey included 119 southwest Virginia participants. Most of the respondents were female (66%), white (89%), and had at least a high school education (79%), and their average age was 41.4 ± 13.5 years. A validated beverage questionnaire was used to measure SSB. Eleven TPB constructs were assessed with a 56-item instrument. Analyses included descriptive statistics, 1-way ANOVA, Cronbach α, and multiple regression. RESULTS Sugar-sweetened beverage intake averaged 457 ± 430 kcal/d. The TPB model provided a moderate explanation of SSB intake (R(2) = 0.38; F = 13.10, P < .01). Behavioral intentions had the strongest relationships with SSB consumption, followed by attitudes, perceived behavioral control, and subjective norms. The 6 belief constructs did not predict significant variance in the models. CONCLUSIONS AND IMPLICATIONS Future efforts to comprehensively develop and implement interventions guided by the TPB hold promise for reducing SSB intake.

The time cost of food at home: general and food stamp participant profiles

Recent research has shown that the typical Supplemental Food Assistance Program (SNAP) family falls short in meeting the Thrifty Food Plan (TFP) nutritional guidelines that underlie the SNAP even when they typically have sufficient monetary resources to eat a healthful diet (i.e. to follow the TFP recommendations). However, the TFP does not consider labor cost. This study uses a basic labor economics technique to value labor in a home food production scenario that is required to reach the TFP nutrition and budget targets and calculates the total cost (inclusive of labor) associated with the TFP. This TFP consistent total cost is then compared, using several metrics, with the total cost associated with actual choices made by those families sharing the same profiles as current SNAP participants. Once labor is included, we find the TFP is not very thrifty and the mean household falls short of the TFP guidelines even with adequate monetary resources.

Talking Health, A pragmatic randomized-controlled health literacy trial targeting sugar-sweetened beverage consumption among adults: Rationale, design & methods

Little is known about the cost of time in food preparation at home. Yet, this economic variable is a common thread running through recent concerns about obesity and the Food Stamp (FS) program. This article provides initial estimates of the time cost in food preparation at home for the United States. Two standard methods of estimation are implemented and three demographic profiles are considered: (i) the general population, (ii) the typical FS participant and (iii) the typical FS participant following the United States Department of Agriculture Thrifty Food Plan. For the general population and averaging across methods, the time cost share of total food cost is about 30% if the individual works in the market and at home, but it is about 49% if the individual does not work in the market. For the typical FS participant, especially one following the Thrifty Food plan, the time cost share of total food cost can be as much as 26% higher than the general population. These substantial percentages provide strong incentives to purchase food away from home and help undermine overall diet quality and the efficacy of the FS program, which ignores the time cost in food at home production.

The Effectiveness and Cost of Lifestyle Interventions Including Nutrition Education for Diabetes Prevention: A Systematic Review and Meta-Analysis

High consumption of sugar-sweetened beverages (SSB) contributes to a wide range of poor health outcomes. Further, few US adults drink less than the recommended ≤8 oz per day; and individuals with low socioeconomic, low health literacy status, and in rural areas are even less likely to meet recommendations. Unfortunately, few SSB behavioral interventions exist targeting adults, and none focus on low health literacy in rural areas. Talking Health, a type 1 effectiveness-implementation hybrid trial targeting adults in rural southwest Virginia, was developed using the RE-AIM planning and evaluation framework (reach, effectiveness, adoption, implementation, maintenance). The primary aim of this pragmatic randomized-controlled trial was to determine the effectiveness of a scalable 6-month intervention aimed at decreasing SSB consumption (SIPsmartER) when compared to a matched contact physical activity promotion control group (MoveMore). SIPsmartER was developed based upon the Theory of Planned Behavior and uses health literacy strategies to improve comprehension of the intervention content among participants. MoveMore is based on a research-tested intervention that was adapted to address all theory of planned behavior constructs and health literacy principles. Secondary aims include additional health outcomes (e.g., physical activity, weight) and reach, adoption, implementation, and maintenance indicators. This paper highlights the opportunities and considerations for developing health behavior trials that aim to determine intervention effectiveness, provide all study participants an opportunity to benefit from research participation, and collect key information on reach and the potential for organizational adoption, implementation, and maintenance with the longer-term goal of speeding translation into practice settings.

Who participates in internet-based worksite weight loss programs?

BACKGROUND Type 2 diabetes is a significant public health concern. With the completion of the Diabetes Prevention Program, there has been a proliferation of studies attempting to translate this evidence base into practice. However, the cost, effectiveness, and cost-effectiveness of these adapted interventions is unknown. OBJECTIVE The purpose of this systematic review was to conduct a comprehensive meta-analysis to synthesize the effectiveness, cost, and cost-effectiveness of lifestyle diabetes prevention interventions and compare effects by intervention delivery agent (dietitian vs non-dietitian) and channel (in-person vs technology-delivered). METHODS English and full-text research articles published up to July 2015 were identified using the Cochrane Library, PubMed, Education Resources Information Center, CAB Direct, Science Direct, and Google Scholar. Sixty-nine studies met inclusion criteria. Most employed both dietary and physical activity intervention components (four of 69 were diet-only interventions). Changes in weight, fasting and 2-hour blood glucose concentration, and hemoglobin A1c were extracted from each article. Heterogeneity was measured by the I2 index, and study-specific effect sizes or mean differences were pooled using a random effects model when heterogeneity was confirmed. RESULTS Participants receiving intervention with nutrition education experienced a reduction of 2.07 kg (95% CI 1.52 to 2.62; P<0.001; I2=90.99%, 95% CI 88.61% to 92.87%) in weight at 12 months with effect sizes over time ranging from small (0.17, 95% CI 0.04 to 0.30; P=0.012; I2= 86.83%, 95% CI 80.42% to 91.14%) to medium (0.65, 95% CI 0.49 to 0.82; P<0.001; I2=98.75%, 95% CI 98.52% to 98.94). Effect sizes for 2-hour blood glucose and hemoglobin A1c level changes ranged from small to medium. The meta-regression analysis revealed a larger relative weight loss in dietitian-delivered interventions than in those delivered by nondietitians (full sample: -1.0 kg; US subsample: -2.4 kg), and did not find statistical evidence that the delivery channel was an important predictor of weight loss. The average cost per kilogram weight loss ranged from

Using National Data to Estimate Average Cost Effectiveness of EFNEP Outcomes by State/Territory

34.06 over 6 months to

Group-based lifestyle sessions for gestational weight gain management: a mixed method approach.

1,005.36 over 12 months. The cost of intervention per participant delivered by dietitians was lower than interventions delivered by non-dietitians, although few studies reported costs. CONCLUSIONS Lifestyle interventions are effective in reducing body weight and glucose-related outcomes. Dietitian-delivered interventions, compared with those delivered by other personnel, achieved greater weight reduction. No consistent trend was identified across different delivery channels.

Dietary quality changes in response to a sugar-sweetened beverage–reduction intervention: results from the Talking Health randomized controlled clinical trial

BackgroundThe reach and representativeness are seldom examined in worksite weight loss studies. This paper describes and illustrates a method for directly assessing the reach and representativeness of a internet-based worksite weight loss program.MethodsA brief health survey (BHS) was administered, between January 2008 and November 2009, to employees at 19 worksites in Southwest Virginia. The BHS included demographic, behavioral, and health questions. All employees were blinded to the existence of a future weight loss program until the completion of the BHS.ResultsThe BHS has a participation rate of 66 percent and the subsequent weight loss program has a participation rate of 30 percent. Employees from higher income households, with higher education levels and health literacy proficiency were significantly more likely to participate in the program (ps < .01).ConclusionsWorksite weight loss programs should include targeted marketing strategies to engage employees with lower income, education, and health literacy.