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Background As obesity rates rise, new weight-loss methods are needed. Little is known about the use of podcasting (audio files for a portable music player or computer) to promote weight loss, despite its growing popularity. Design A 12-week RCT was conducted. Setting/participants The study sample comprised overweight men and women (BMI=25–40 kg/m 2 ; n =78) in the Raleigh–Durham NC area. Intervention In 2008, participants were randomly assigned to receive 24 episodes of a currently available weight-loss podcast (control podcast) or a weight-loss podcast based on social cognitive theory (SCT) designed by the researchers (enhanced podcast) for 12 weeks. Main outcome measures Weight was measured on a digital scale at baseline and follow-up. Both groups also completed questionnaires assessing demographic information, food intake, physical activity, and SCT constructs at the introductory and 12-week meetings. Additional questionnaires at the 12-week meeting assessed perceptions of the intervention. Results Data collection and analysis occurred in 2008 and intention-to-treat was used. Enhanced group participants ( n =41) had a greater decrease in weight (−2.9±3.5 kg enhanced group vs −0.3±2.1 control group; p 2 enhanced group vs −0.1±0.7 kg/m 2 control group; p n =37) and had greater weight-loss–related knowledge ( p p p p Conclusions The results of this study suggest that the use of behavioral, theory-based podcasting may be an effective way to promote weight loss. Trial registration NCT00771095

When encountering new or understudied populations, it is useful to build an understanding of the needs and perceptions of the target audience. This study investigated the application of the qualitative pile sort method for gaining information about nutrition and physical activity behaviors. In a pile sort, individuals make a list of topics relevant to a particular subject, and then they group these topics into related piles. This study investigated whether there was consistency in the ways in which participants grouped behaviors related to having a healthful lifestyle. Pile sorts were conducted during six focus groups among 28 female community college students (46% white; 39% had a 2-year degree or higher). A total of 74 piles of grouped behaviors were coded from the transcripts. Analyses revealed good consistency (identified nine to 12 times) for four groupings: exercise, lifestyle, how you eat, and positive foods. The pile sort method represents an activity that can be incorporated into formative research for interventions focused on complex behaviors with multiple components; in addition, this method may provide structure to counseling sessions and facilitate a better understanding of the perceptions of healthful eating and physical activity from patients' perspectives.

Purpose To compare the effectiveness of a Web-based physical activity (PA) intervention with identical content delivered in a printed workbook among a sample of adolescent girls. Methods Participants consisted of 319 girls with home Internet access enrolled in four middle schools within one school district. A randomized trial design was used to compare changes in PA self-efficacy and intentions after two weeks of exposure to either a Web- or print-based intervention delivered to their home. Self-reported physical activity was assessed as a secondary outcome. Analysis of covariance was conducted to determine changes between the intervention groups while controlling for baseline levels of PA constructs. Results Both Web and print groups had significant changes in physical activity self-efficacy (Web: t [155] = 2.58, p = .01; print: t [156] = 3.11, p = .002) and intentions (Web: t [157] = 2.27, p = .02; print: t [159] = 6.32, p ≤ .001). The print group demonstrated significantly greater increases in intentions compared with the Web group ( F [1,315] = 13.53, p ≤ .001). Self-reported physical activity increased significantly in the print group only ( t [159] = 3.21, p = .002). Conclusions It cannot be assumed that new media technologies are superior to traditional media such as print for health communication to adolescents. These results suggest that a printed workbook was more effective than an identical website for increasing physical activity intentions and behavior among a sample of middle school girls.

Background People who choose to take dietary supplements are often classified as having a healthful lifestyle; however, it is probable that several health behavior patterns exist among users. Objective Data from the North Carolina Strategies to Improve Diet, Exercise, and Screening study (N=727) were used to identify and describe five different categories of dietary supplement use and evaluate how these categories are associated with both quantity and quality of fruit and vegetable consumption. Design Five nonoverlapping dietary supplement use categories were created and descriptive demographic statistics were compared. Least-squares means were calculated for knowledge and fruit and vegetable quality and quantity measures. Logistic regression was performed to calculate adjusted odds ratios to examine associations among the dietary supplement use categories and the fruit and vegetable measures, using nonusers as the reference category. Results Demographic profiles and dietary intake varied among the dietary supplement categories. People reporting both a multivitamin/multimineral and a single supplement (Multi Plus category) and any nonvitamin/nonmineral products (Herbals category) were more likely to be consuming more vegetables and higher-quality fruits and vegetables than those not taking any dietary supplements (Nonusers category), whereas people taking multivitamins/multiminerals only (Multis category) had patterns that were more consistently similar to those not taking any dietary supplements (Nonusers). Conclusions Study participants exhibited dietary supplement use patterns that were associated with differences in fruit and vegetable consumption. Simply characterizing people as users and nonusers will not capture critical demographic and dietary differences and will likely further cloud investigations of diet–disease relationships.

Objectives: Body and Soul was a collaborative effort among two research universities, a national voluntary agency (American Cancer Society), and the National Institutes of Health to disseminate and evaluate under real-world conditions the impact of previously developed dietary interventions for African Americans. Methods: Body and Soul was constructed from two successful research-based interventions conducted in African-American churches. Components deemed essential from the prior interventions were combined, and then tested in a cluster randomized–effectiveness trial. The primary outcome was fruit and vegetable intake measured with two types of food frequency questionnaires at baseline and 6-month follow-up. Results: At the 6-month follow-up, intervention participants showed significantly greater fruit and vegetable (F&V) intake relative to controls. Post-test differences were 0.7 and 1.4 servings for the 2-item and 17-item F&V frequency measures, respectively. Statistically significant positive changes in fat intake, motivation to eat F&V, social support, and efficacy to eat F&V were also observed. Conclusions: The results suggest that research-based interventions, delivered collaboratively by community volunteers and a health-related voluntary agency, can be effectively implemented under real-world conditions.

This article describes the development and randomized evaluation of a tailored nutrition education CD-ROM program for participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in North Carolina.After randomization to intervention or control groups, participants completed a baseline survey and were resurveyed immediately after program use and 1 to 2 months postintervention.Two WIC clinics in central North Carolina.A total of 307 respondents to the follow-up survey (response rate 74.8%) comprised the study sample. Participants were female (96%), 20% were pregnant, and 50% were minorities (African American and other).The interactive CD-ROM consisted of a targeted video soap opera, dietary assessment, and individually tailored dietary feedback and strategies for change.Measures included total fat and fruit and vegetable intake, knowledge of low-fat and infant feeding choices, self-efficacy, and stages of change.Descriptive statistics assessed baseline comparability of study groups; analysis of covariance and F tests were used to assess program effects at follow-up.INTERVENTION group members increased self-efficacy (P.01) and scored significantly higher (P.05) on both low-fat and infant feeding knowledge compared with controls. No differential effect was observed for dietary intake variables.The findings suggest that one dose of an interactive CD-ROM program can impact mediators of dietary change but may be insufficient to change behavior.

Background. This study assessed the effects of the Health Works for Women (HWW) intervention on improving multiple behaviors including nutrition and physical activity among rural female blue-collar employees in North Carolina. Methods. Nine small to mid-size workplaces were randomly assigned to either intervention or delayed intervention conditions. After a baseline survey, an intervention consisting of two computer-tailored magazines and a natural helpers program was conducted over 18 months. Delayed worksites received one tailored magazine. Approximately 77 and 76% of baseline respondents completed follow-up surveys at 6 and 18 months, respectively, and 538 women (63%) completed all three surveys. Results. At the 18-month follow-up, the intervention group had increased fruit and vegetable consumption by 0.7 daily servings compared to no change in the delayed group (P < 0.05). Significant differences in fat intake were observed at 6 months (P < 0.05) but not at 18 months. The intervention group also demonstrated improvements in strengthening and flexibility exercise compared to the delayed group. The rates of smoking cessation and cancer screening did not differ between study groups. Conclusions. The HWW project was a successful model for achieving certain health behavior changes among blue-collar women.

Background: Direct entry of personal health survey information into a computer by patients could streamline clinical data collection, improve completeness and accuracy of health information available to providers, and provide data for tailoring health education messages. Few computerized programs, however, have been developed to adapt the interface to diverse literacy levels, language, computer skills, and health literacy levels of the broad spectrum of patient populations. Methods: To develop such a program, we conducted cognitive response interviews with a diverse sample of 21 adult participants from two North Carolina health clinics. Participants were placed into one of three interview categories: (1) low reading skill level, low computer skills; (2) high reading skill level, low computer skills; and (3) high reading skill level, high computer skills. The “think-aloud” technique was employed to elicit feedback on a series of computer interface screens and health risk assessment questions. Results: Interface-related findings showed that preference for touchscreen versus keyboard data entry was not strongly related to computer skill level but was related to question type. Respondents with limited education indicated that they would not click on a “help” or hyperlink option to get more information and that frequent reminders of directions on the screen were needed. Content-related findings showed numerous misperceptions regarding meanings of common health questions and terminology (e.g., seat belt use and intravenous drugs). Conclusions: These findings have implications for health literacy and may have an impact on the accuracy of information obtained. Study results will be incorporated into the development and testing of an innovative, adaptive multimedia program.

Objective To evaluate the effectiveness of computer-tailored newsletter interventions in improving the number and variety of fruits and vegetables eaten by adults. Design The 4-group randomized trial with pre- and post-intervention measures consisted of a control group and 3 intervention groups receiving nontailored newsletters, computer-tailored newsletters, or tailored newsletters with tailored goal-setting information. Intervention groups received 1 newsletter each month for 4 months. Subjects Baseline surveys were completed by 710 health maintenance organization clients. Postintervention surveys administered 6 months after baseline were completed by 573 participants (80.8%). Intervention All newsletters contained strategies for improving fruit and vegetable consumption. Tailored newsletters used computer algorithms to match a person's baseline survey information with the most relevant newsletter messages for promoting dietary change. Main outcome measures Daily intake and weekly variety of fruits and vegetables were measured using a food frequency questionnaire. Statistical analyses performed Analysis of covariance and Tukey's honestly significant difference test were used to assess differences in the number and variety of fruits and vegetables consumed among intervention groups. Results For persons completing postintervention surveys (n=573), all 3 newsletter groups had significantly higher daily intake and variety scores compared with the control group. Although there was a trend of improved intake and variety with each added newsletter element, there were no significant differences at follow-up among the newsletter groups. Conclusions Newsletters can be effective in improving the fruit and vegetable consumption of adults. In this study, a computer-tailoring system did not significantly enhance the effect of the nutrition newsletters on fruit and vegetable intake. J Am Diet Assoc. 1999;99:705–709 .

Open University, Department of Social Sciences, Netherlands. HANS.BRUG@OUH.NLComputer-tailored nutrition education may be more effective than general nutrition education because messages are tailored to individual behavior, needs and beliefs of subjects. Therefore, the messages are likely to be of more personal relevance and may have stronger motivational effects. Computer-generated nutrition education has been studied for different dietary behaviors, in different target populations, and in different settings. In recent years, eight studies have been published that assessed the impact of comprehensive computer-generated nutrition interventions that were based on behavior change theory. In this article, the process of providing people with computer-tailored nutrition education is described and the studies on the impact of computer-tailored nutrition education are reviewed. The results point to the conclusion that computer-tailored nutrition education is more likely to be read, remembered, and experienced as personally relevant compared to standard materials. Furthermore, computer-tailored nutrition education also appears to have a greater impact in motivating people to change their diet, their fat intake in particular, although at present no definite conclusions can be drawn.

Introduction The Maternal Outreach Worker (MOW) Program is a social support intervention using lay helpers to provide support, health education, and outreach to Medicaid eligible women at risk for poor pregnancy and parenting outcomes. State Health Department and University collaborators designed a two-pronged evaluation comprised of programwide and interview study components to assess the impact of the program on pregnancy outcomes, health behaviors, and infant health status. Methods Programwide evaluation data are based on 1992–1995 N.C. birth files for the original 24 participating counties and include 1,726 MOW participant births and 12,988 comparison births whose records were linked to birth files and met the study criteria. For the interview study 373 MOW participants and 332 comparison women were personally interviewed three times: during pregnancy, one month postpartum, and one year after delivery. Results Risk factors associated with poor pregnancy and parenting outcomes were greater among MOW participants than comparisons in both the programwide and intensive study components. Caucasian MOW participants had slightly higher rates of adequate prenatal care. African Americans were found to have less adequate prenatal care. Fewer than expected LBW and VLBW births were observed for African-American MOW participants. MOW Program participation did not affect the utilization of health and social services for infants. African Americans, regardless of whether they received MOW services, fared better than Caucasians in terms of having their pregnancy needs fulfilled. Conclusions Findings show the need to further explore appropriate measures of maternity support program outcomes and indicate inconsistent program benefit among subpopulations.