Isobel Contento, Ph.D., CDN Department of Health and Behavior Studies Teachers College, Columbia...

Isobel Contento, Ph.D., CDNDepartment of Health and Behavior Studies

Teachers College, Columbia University

National Obesity Prevention Conference, October 27, 2004

How Do We Design Effective, Integrated Nutrition Education

Programs: Research Needs

Biologically determined behavioral

predispositions:

•Taste/pleasure •Sweet, sour, salt, bitter

•Hunger/satiety mechanisms•Sensory specific satiety

•Brain mechanisms

Experience with food: Associative conditioning

Physiological conditioning:•Familiarity: learned safety

•Conditioned preferences

•Conditioned satiety

Social conditioning:•Models•Rewards•Social affective context

Intra-personal factors:

•Beliefs•Attitudes •Expectancies•Benefits•Barriers•Self-efficacy•Self identity•Moral/ethical•Stage in change process•Knowledge & skills

Environmental factors:

Socialenvironment:•Social networks & relationships•Cultural practices

Physical environment

•Food availability (under & over)•Technology

Informational Environment•Advertising•Education•Media

Interpersonal factors:•Social norms•Cultural norms

FOOD BEHAVIORS

Contento 2000

Economicenvironment•Resources•Price

Biologically determined behavioral

predispositions:•Taste/pleasure

•Sweet, sour, salt, bitter•Hunger/satiety mechanisms

•Sensory specific satiety•Brain mechanisms

Experience with food: Associative conditioning

Physiological conditioning:•Familiarity: learned safety

•Conditioned preferences

•Conditioned satiety

Social conditioning:•Models•Rewards•Social affective context

Intra-personal factors:

•Beliefs•Attitudes •Expectancies•Benefits•Barriers•Self-efficacy•Self identity•Ethical/moral obligations•Ethnic identities•Stage in change process•Knowledge & skills

Environmental factors:

Socialenvironment:•Social networks & relationships•Cultural practices

Physical environment

•Food availability (under & over)•Technology

Informational Environment•Advertising•Education•Media

Interpersonal factors:•Social norms•Cultural norms

NUTRITIONINTERVENTIONS

Contento, SNE, July 27, 2003

Economicenvironment•Resources•Price/cost

SOCIAL-ECOLOGICAL MODEL

A theory-based framework to characterize the variety of influences on nutrition and physical activity behaviors and the potential levels of interventions for obesity prevention

Gregson, Forester, Orr, et al., JNE, 2001;33:S4-15McLeroy, Bibeau, Steckler, Glanz. Health Ed Q. 1988;15:351-377

IndividualBiological givens

Experience with food

Beliefs, attitudes

Knowledge

Interpersonal factors:

Family Peers

Social networks

Institutional/organizational

Social structure

Interventions

Community

Policy

Systems

Local, state,federal

Social networksNorms Standards

Rules, policies,informal networks

Spheres of Influence

OVERWEIGHT PREVENTION STUDIES


Study Target Group

Target Behaviors

Intervention Findings

Donnelly, 1996CCT

3-5th graders

n =338

Metabolic fitness via diet and PA

School meals - lower fatNE - 9 sessions/yearPA -- 3x week

At end of yr 2:BMI - nsMetabolic fitness - ns

Flores, 1995RCT

10-13 yrs

AA, Hispanic

n =110

Aerobic exercise Aerobic dance in school PE 3x week, 12 weeks

BMI p<.05 girls

Jeffery & French1997RCT

Community adults

Ages 20-45 y

n =1226

Men & women, hi & low-income

Prevention of wt gain through eating and exercise

1. Education = mthly newsletters + classes 2x/year

2. Education + lottery

3. No-contact control

Weight gain-ns

Diet - ns

PA - ns

Less wt gain in hi income than low income


Study Target Group

Target Behaviors


Gortmaker 1999Cluster RCT

Planet Health

6-8th graders

Mixed ethnicity

(n=1295)

TV /videoHi-fat foodsF&VMVPA

16 lessons each yr/2 years in 4 subject areas PE -- MVPA + 30 5-min lessons for goal-setting

BMI + TSF p<.05 for girls TV *Fat & cals *girlsF&V *girlsPA - ns

Robinson1999Cluster RCT

3-4th graders

Mixed ethnicity

(n=192)

TV/video 18 lessons- 2 mo. TV turnoff for 10 days

TV --> 7 hr/week Home - newsletters

+TV time manager

BMI*, TSF *

TV *

Meals w/TV *

PA -ns

Hi fat foods -ns


Study Target Group

Target Behaviors


Pathways:Caballero2003RCT

3-4th gradersAmerican Indian

Az, NM & SD(n=1704)

Healthful foods(lo fat and hi F&V)

PA

Foods served: lower fat PE - 30 min 3/wk MVPA(SPARK) Classroom: 45 min 2xwk,12 weeks in grades 3&4; 8 weeks in grade 5. Family nights, home action packs

% body fat - nsBMI - ns% fat in school lunch*24-hr recalls: calorie intake*% fat*Accelerometer- nsPA Quest - ns


Study

(pilot)

Target Group

Target Behaviors


Neumark-Sztainer2003

New Moves

9-10th grade

girls(n=201)

Mixed ethnicity

PA

Eating patterns

_____________

Self-perceptions

Social support

PE alternative class for credit

5/wk, 16 weeks

______________

PA 4x/wk

Social support 1x /2 wks

Nutr. guidance 1x /2 wks

BMI -ns

Self-perceptions -ns

PA - ns

Eating patterns - ns


Study(pilots)

Target Group

Target Behaviors


GEMSStanford, CA2003

8-10 yr old AA girls +Families(n=61)

PA

TV/video

After school dance class in community centers - 12 weeks 5 lessons in the home to reduce TV

BMI, waist - trSelf TV - trFamily TV* Dinners w/TV*Concern weight*

GEMS Minnesota2003

8-10 yr old

AA girls + families

(n=54)

PA

Healthy eating

After school PA + healthy eating 2/wk, 12 weeks

BMI - ns

PA - tr

Diet - tr

Pycho-social - tr

Girls health Enrichment Multi-site Studies


Study(pilots)

Target Group

Target Behaviors


GEMSBaylor, TX2003

8-10 yr old AA girls +Families(n=35)

FJV

PA

4-week summer 8-week home Internet

BMI -tr

Other measures -tr

GEMSTennessee2003

8-10 yr old

AA girls +

families

(n=60)

Sweetened beverages

Water

PA

Child weekly sessions Parent sessions

12 weeks

BMI, waist -tr

Sweet bev. - 34%

Water - 1.5%

MVPA - 12%

DESIGNING PROGRAMS: RESEARCH NEEDS

Behavioral targets

Theory

Intervention /Strategies

Evaluation issues


Behavioral targets:Eating Patterns: Increase F & V; healthy eating; water Decrease: low-fat foods; sweetened sodas

Physical Activity: Increase MVPA; Decrease TV/ video


Behavioral targetsEating Patterns: Increase F & V; healthy eating; water Decrease: low-fat foods; sweetened sodas

Physical Activity: Increase MVPA; Decrease sedentary behavior: TV/ video

Weight as outcome?


Behavioral targets Eating Patterns: Increase F & V; healthy eating; water Decrease: low-fat foods; sweetened sodas


Eat less


Behavioral targets Eating Patterns: Increase F & V; healthy eating; water Decrease: low-fat foods; sweetened sodas


Eat less: conscious/ competent eating


Theory: Specifies relations among variables in order to explain and predict events (e.g. food or PA behaviors):

Biological }Psychosocial } variables Diet and PA behaviorsBehavioral } (predict)Environmental}


Theory:

Nutrition/ ---> change in predictors --> change in PA of behaviors behaviors interventions specified by theory

(mediating variables)


Theory: Predictiveness of most current theories or models have been modest (r2 < 0.3) Need to explore more relevant/ additional mediating variables Theory that takes into account the complexities of food choice Theory that helps us understand how individuals and the environment interact. Qualitative studies/grounded theory Best practices/field studies to inform theory development

Baranowski et al. Ann Rev Nutr 1999;19:17-40Baranowski et al. Am J Prev Med 1998;15:266-297Baranowski et al. Obesity Res 2003;11:23S-43


Intervention Strategies and Implementation Duration and intensity

Fidelity to intervention as designed

Strategies Individual versus environmental Eating patterns versus PA Scaling up from micro-level to community level


Intervention Strategies and Implementation

Strategies Settings Research with large sample of those who have managed to remain at a healthy weight Carefully documenting school & community programs e.g. farm to school programs; school meal changes


Carefully documenting school & community programs

Shaping America’s Youth: Survey (September 2004) 1500 organizations sent survey: might fund or conduct programs addressing “physical activity and excess weight in childhood”: 1200 responded

1831 active programs: 240 childhood overweight intervention; 369 prevention;

242 prevention all ages; 621 general health/fitness, 120 research; 205 other. 2004 expenditures = $3.9 billion (low estimate) to $7 billion (mid estimate) Therefore: many programs already operating. Careful evaluation and documentation would move the field forward.


Evaluation and measurement issues Standardized instruments: individualized interventions Measures : reliability and validity & how administered Instruments: Research vs practice settings Studies: Cross-sectional and/or short term Food choice & PA behaviors are very complex: Measuring choices and trade-offs


Behavioral targets

Theory

Intervention /Strategies

Evaluation and Measurement issues

IndividualBiological givens

Experience with food

Beliefs, attitudes

Knowledge

Interpersonal factors:

Family Peers

Social networks

Institutional/organizational

Social structure

Interventions

Community

Policy

Systems

Community programsBike-paths

School meals Physical educationWorksites

Leverage points

Food system

Isobel Contento, Ph.D., CDN Department of Health and Behavior Studies Teachers College, Columbia...

Documents

Transcript of Isobel Contento, Ph.D., CDN Department of Health and Behavior Studies Teachers College, Columbia...