Didactic Program in Dietetics, Health and Nutritional Sciences, South Dakota State University, Brookings, SD.
Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ.
J Nutr Educ Behav. 2014 Nov-Dec;46(6):S27-41. doi: 10.1016/j.jneb.2014.08.007. Epub 2014 Nov 7.
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.
目的:评估基于理论的、通过网络提供的定制干预措施(年轻人健康饮食与活动)的有效性,该措施是使用基于社区的参与式研究过程开发的。
设计:一项为期 15 个月(10 周密集干预,为期 12 个月的随访)的随机对照试验,通过互联网和电子邮件进行。
地点:13 个大学校园。
参与者:共有 1639 名大学生。
干预措施:21 个迷你教育课程和电子邮件(称为提示),采用非节食方法,重点关注饮食行为、身体活动、压力管理和健康体重管理。提示内容简短、频繁、有趣,且根据每个行为进行阶段定制,并强化课程内容。
主要结局测量:所有参与者在基线、干预后(从基线起 3 个月)和随访(从基线起 15 个月)时,对体重、体重指数(BMI)、水果和蔬菜摄入量(FVI)、身体活动(PA)和感知压力进行主要结局测量;对腰围、膳食脂肪百分比、含糖饮料摄入的能量、全谷物的份数、用餐行为的自我指导和调节、睡眠时间和 5 杯 FVI、每周 150 分钟 PA 和每周大多数日子管理压力的改变阶段进行次要结局测量。在基线时收集人口统计学数据。
分析:采用卡方分析和混合模型重复测量分析来确定实验组和对照组结果之间的差异。
结果:实验组和对照组参与者在 BMI、体重和腰围方面没有差异。FVI(P=0.001)、女性剧烈 PA(P=0.05)、脂肪摄入(P=0.002)、自我指导(P=0.001)和调节(P=0.004)方面有较小的改善饮食行为,以及睡眠时间(P=0.05)在干预后有所改善,但在随访时没有维持。在干预后,实验组参与者在 FVI(P=0.019)和 PA(P=0.002)方面处于行动/维持阶段的比例高于对照组。
结论和意义:年轻人健康饮食与活动是首批使用基于社区的参与式研究过程(即 PRECEDE-PROCEED)开发非节食方法干预措施的研究之一。尽管实验组和对照组参与者在体重变化或 BMI 方面没有差异,但该干预措施支持了在可能导致体重过度增加的行为上的积极变化,例如在干预后立即增加 FVI 和更健康的自我调节用餐行为。需要探索维持行为变化的其他策略。
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