Behavior Change to Save Energy in Low-Income, Urban Households

Background. Highly processed foods are inexpensive and abundant in our food supply, nutritionally poor, and disproportionately marketed to minority youth. This study is part of a curriculum development project to develop, implement, and evaluate the In Defense of Food (IDOF) curriculum designed to increase intake of whole/minimally processed foods and decrease intake of highly processed foods in youth. Aims. This pilot outcome evaluation was undertaken to assess initial effectiveness and to provide an in-depth understanding of changes in behavioral outcomes and psychosocial mediators. Methods. We used an explanatory mixed method approach, including a single-arm pretest–posttest of intervention effect, followed by a food rules assessment and in-depth interviews to describe participant responses to the intervention in more detail. The study was conducted in three afterschool classrooms in urban low-income neighborhoods with 32 multiethnic middle-school youth, receiving 10 weekly 2-hour sessions. Results. Two weeks postintervention, there was a large positive significant increase in whole/minimally processed food intake ( p < .01; d = 0.59) and a small decrease in consumption of highly-processed foods ( p = ns; d = 0.06), compared with baseline. Significant increases in psychosocial mediators: Self-efficacy and positive outcomes expectations were seen; others were not significant but changed in the desired direction. Qualitative assessments suggest that the intervention promoted skill building, but environmental barriers made these difficult to use. Discussion. The IDOF curriculum may be most effective for promoting consumption of fruits and vegetables, rather than decreasing intake of highly processed foods. In addition, in this young age-group, short actionable food rules may support self-regulation and behavior change. Conclusion. Among adolescent students in low-income urban neighborhoods, the IDOF afterschool curriculum may help promote self-efficacy and positive outcome expectancies and increase fruit and vegetable intake. Focusing on food processing and using “Food Rules” may be promising to elicit behavior change in youth; however, greater supports are needed to overcome social and environmental barriers.

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Is the adapted Radimer/Cornell questionnaire valid to measure food insecurity of urban households in Tehran, Iran?

Public Health Nutrition ◽

10.1017/s1368980007441465 ◽

2007 ◽

Vol 10 (8) ◽

pp. 855-861 ◽

Cited By ~ 18

Author(s):

Nahid Zerafati_Shoae ◽

Nasrin Omidvar ◽

Mahmood Ghazi-Tabatabaie ◽

Anahita Houshiar_Rad ◽

Hajieh Fallah ◽

...

Keyword(s):

Factor Analysis ◽

Food Insecurity ◽

Low Income ◽

Occupational Status ◽

Reproductive Age ◽

Validity And Reliability ◽

Urban Households ◽

Consumption Frequency ◽

Culturally Different ◽

Child Hunger

AbstractObjectiveTo assess the validity of the adapted Radimer/Cornell questionnaire to measure food insecurity in low-income urban households in Tehran, the capital of Iran.DesignThe Radimer/Cornell questionnaire was modified and used to assess the applicability, validity and reliability of such a measure in a culturally different context of urban households in Tehran. Factor analysis and Cronbach's α were used to assess validity and reliability, respectively. Socio-economic characteristics and food consumption frequency of the household were used to assess the criterion validity of the questionnaire.SettingDistrict 20 of Tehran.SubjectsA sample of 250 Iranian nuclear households with at least one child aged 1–18 years and a non-pregnant, non-lactating woman of reproductive age, selected through a multistage random sampling method.ResultsThree scales, labelled as household, individual and child hunger, were extracted through factor analysis using varimax rotation. Internal consistency of the scales was 0.897, 0.820 and 0.796, respectively. Individual insecurity and child hunger were inversely correlated with monthly per capita income, father's education, mother's education and father's occupational status, and positively correlated with household size, as expected. However, household insecurity did not follow the same pattern. Consumption frequency of fruits, vegetables, dairy, red meat and rice declined as food insecurity status worsened, while bread and potato consumption increased.ConclusionThe results show that a modified version of the Radimer/Cornell questionnaire is a valid and reliable instrument to measure household food insecurity in a culturally different context. However, further modifications seem necessary to measure food insecurity at household level. Results lend support to the utility and applicability of experience-based measures in varying cultural communities.

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Promoting Smoke-Free Homes Through Biomarker Feedback Documenting Child Exposure to Tobacco Toxins: Protocol for a Randomized Clinical Trial (Preprint)

10.2196/preprints.12654 ◽

2018 ◽

Author(s):

Janet Leigh Thomas ◽

Meredith Schreier ◽

Xianghua Luo ◽

Sue Lowry ◽

Deborah Hennrikus ◽

...

Keyword(s):

Clinical Trial ◽

Behavior Change ◽

Randomized Clinical Trial ◽

Low Income ◽

Smoking Behavior ◽

Self Report ◽

Child Exposure ◽

Smoking Restrictions ◽

Tobacco Carcinogen ◽

Shs Exposure

BACKGROUND Exposure to secondhand smoke (SHS) early in life increases the risk of sudden infant death syndrome (SIDS), asthma, and respiratory illnesses. Since children’s primary exposure to SHS occurs in the home, these most vulnerable members of our society are not fully protected by recent increases in the adoption of smoking bans in public spaces. Although exposure to SHS is a quickly reversible cause of excess morbidity, few low-income homes strictly enforce smoking restrictions. OBJECTIVE This study aims to test a novel approach to motivate the adoption of home smoking restrictions and to eliminate child SHS exposure by providing parents with objective data documenting home SHS exposure and “biomarker feedback” of child ingestion of tobacco toxins, that is, objective, laboratory-based results of assays performed on child urine, documenting levels of nicotine; cotinine; and NNAL (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol), which is a metabolite of the known tobacco carcinogen NNK (4-[methylnitro-samino]-1-[3-pyridyl]-1-butanone). METHODS From 2011 to 2013, 195 low-income, female smokers with children aged ≤10 years residing in their homes were recruited into a two-arm randomized clinical trial. Participants were assigned to one of two groups: biomarker feedback (n=98) and health education (n=97). In-home assessments were administered at baseline, week 16, and week 26. Children’s home SHS exposure and nicotine, cotinine, and NNAL levels from urine samples, measured through a passive nicotine dosimeter and a surface sample of residual tobacco smoke (ie, thirdhand smoke), were collected at all three time points. Primary outcome was dosimeter-verified, self-reported complete home smoking restrictions at 6 months after randomization. Secondary outcomes included parental self-report of smoking behavior change and child urine tobacco toxin (biomarker) change. RESULTS Data collection and analyses are complete, and the results are being interpreted. CONCLUSIONS The study protocol describes the development of a novel community-based controlled trial designed to examine the efficacy of biomarker feedback documenting home and child exposure to SHS on parental smoking behavior change. INTERNATIONAL REGISTERED REPORT RR1-10.2196/12654

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A Goal Setting Intervention Positively Impacts Adolescents’ Dietary Behaviors and Physical Activity Self-Efficacy

Journal of Youth Development ◽

10.5195/jyd.2012.120 ◽

2012 ◽

Vol 7 (4) ◽

pp. 92-108 ◽

Cited By ~ 1

Author(s):

Mical Kay Shilts ◽

Marilyn S. Townsend

Keyword(s):

Physical Activity ◽

Behavior Change ◽

Youth Development ◽

Goal Setting ◽

Low Income ◽

Self Efficacy ◽

Repeated Measures ◽

Goal Attainment ◽

Cognitive Theory ◽

Dietary Behaviors

The efficacy of a youth development intervention on improving eating and physical activity(PA) self-efficacy, goal attainment scaling, goal effort, and behaviors was examined in a repeated measures, quasi-experimental field trial. Ethnically diverse students (n=64) from a low-income middle school participated in the 10-session intervention driven by the Social Cognitive Theory with a Goal Setting Theory emphasis. Participants, 13-14 years old, made significant changes in dietary behaviors (P=0.03) and PA self-efficacy (P=0.02) after receiving the intervention. Self-efficacy did not mediate dietary behavior change but did mediate the small changes made in PA. Goal effort was not a mediator of behavior change. After the intervention, more participants rated themselves as making one lasting improvement in eating (P

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Promoting Smoke-Free Homes Through Biomarker Feedback Documenting Child Exposure to Tobacco Toxins: Protocol for a Randomized Clinical Trial

JMIR Research Protocols ◽

10.2196/12654 ◽

2019 ◽

Vol 8 (10) ◽

pp. e12654 ◽

Cited By ~ 1

Author(s):

Janet Leigh Thomas ◽

Meredith Schreier ◽

Xianghua Luo ◽

Sue Lowry ◽

Deborah Hennrikus ◽

...

Keyword(s):

Clinical Trial ◽

Behavior Change ◽

Randomized Clinical Trial ◽

Low Income ◽

Smoking Behavior ◽

Self Report ◽

Child Exposure ◽

Smoking Restrictions ◽

Tobacco Carcinogen ◽

Shs Exposure

Background Exposure to secondhand smoke (SHS) early in life increases the risk of sudden infant death syndrome (SIDS), asthma, and respiratory illnesses. Since children’s primary exposure to SHS occurs in the home, these most vulnerable members of our society are not fully protected by recent increases in the adoption of smoking bans in public spaces. Although exposure to SHS is a quickly reversible cause of excess morbidity, few low-income homes strictly enforce smoking restrictions. Objective This study aims to test a novel approach to motivate the adoption of home smoking restrictions and to eliminate child SHS exposure by providing parents with objective data documenting home SHS exposure and “biomarker feedback” of child ingestion of tobacco toxins, that is, objective, laboratory-based results of assays performed on child urine, documenting levels of nicotine; cotinine; and NNAL (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol), which is a metabolite of the known tobacco carcinogen NNK (4-[methylnitro-samino]-1-[3-pyridyl]-1-butanone). Methods From 2011 to 2013, 195 low-income, female smokers with children aged ≤10 years residing in their homes were recruited into a two-arm randomized clinical trial. Participants were assigned to one of two groups: biomarker feedback (n=98) and health education (n=97). In-home assessments were administered at baseline, week 16, and week 26. Children’s home SHS exposure and nicotine, cotinine, and NNAL levels from urine samples, measured through a passive nicotine dosimeter and a surface sample of residual tobacco smoke (ie, thirdhand smoke), were collected at all three time points. Primary outcome was dosimeter-verified, self-reported complete home smoking restrictions at 6 months after randomization. Secondary outcomes included parental self-report of smoking behavior change and child urine tobacco toxin (biomarker) change. Results Data collection and analyses are complete, and the results are being interpreted. Conclusions The study protocol describes the development of a novel community-based controlled trial designed to examine the efficacy of biomarker feedback documenting home and child exposure to SHS on parental smoking behavior change. International Registered Report Identifier (IRRID) RR1-10.2196/12654

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Design and rationale of the Longitudinal Evaluation of Norms and Networks Study (LENNS): A cluster-randomized trial assessing the impact of a norms-centric intervention on exclusive toilet use and maintenance in peri urban communities of Tamil Nadu

10.1101/2020.06.26.20140830 ◽

2020 ◽

Cited By ~ 1

Author(s):

Sania Ashraf ◽

Cristina Bicchieri ◽

Maryann G. Delea ◽

Upasak Das ◽

Kavita Chauhan ◽

...

Keyword(s):

Behavior Change ◽

Randomized Trial ◽

Low Income ◽

Tamil Nadu ◽

Cluster Randomized Trial ◽

List Type ◽

Behavior Change Intervention ◽

Ex Ante ◽

Cluster Randomized ◽

The Impact

AbstractIntroductionInconsistent toilet usage is a continuing challenge in India. Despite the impact of social expectations on toilet usage, few programs and studies have developed theoretically grounded norms-centric behavior change interventions to increase toilet use in low-income settings. This protocol details the rationale and design of an ex-ante, parallel cluster-randomized trial evaluating the impact of a demand-side, norms-centric behavior change intervention on exclusive toilet use and maintenance in peri-urban Tamil Nadu, India.Methods and AnalysisFollowing two years of formative research, we developed an evidence-based norm-centric behavior change intervention called Nam Nalavazhvu (Tamil for “Our wellbeing”). The multi-level intervention aims to shift collective beliefs by shifting empirical expectations or beliefs about other relevant people’s sanitation practices. It also provides action-oriented information to aid individuals to set goals and overcome barriers to build, consistently use and maintain their toilets. This trial includes 76 wards in Pudukkottai and Karur districts, where half were randomly assigned to receive the intervention and the remaining serve as counterfactuals. During baseline and endline (conducted one year after the initiation of intervention) assessments, we collect relevant data and compare results between study arms to determine the impacts of the Nam Nalavazhvu intervention on sanitation-related behavioral, health, wellbeing outcomes and potential moderators. This study is powered to detect differences in the prevalence of exclusive toilet use between study arms. We will also conduct a process evaluation to understand the extent to which the intervention was implemented, as designed.Ethics and DisseminationThe study protocol has been reviewed and approved by the ethics board at the University of Pennsylvania, USA and the Catalyst Foundation, India. Research findings will be disseminated through open access peer reviewed publications and presentations to stakeholders, government officials and conferences.Trial registrationNCT04269824.Strengths and limitations of this studyThis ex-ante, parallel cluster randomized trial assesses the impact of a norm-centric behavior change intervention strategy to improve sanitation practices. These behavior change techniques are novel to the sanitation sector but has been effective in changing a variety of behaviors, such as water use, drinking behavior, and energy consumption.The study outcomes include health, wellbeing outcomes, and a careful assessment of changes in social beliefs, expectations, and social determinants of collective sanitation behaviors.This study is being rolled out during the ongoing COVID-19 pandemic. This can potentially impact the effectiveness of this intervention package that uses community and network-based group activities. However, through a detailed process monitoring and evaluation we will be able to assess the impact on delivery, and subsequent behavior change in this unique setting.

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