# Presentation: 887347

## RELATIVE PAY-OFFS FOR INTERVENTIONS THAT FOCUS ON INDIVIDUALS VERSUSTHE ENVIRONMENT

- Debbe Thompson, PhD
- Children’s Nutrition Research Center
- Baylor College of Medicine
- October 27, 2004
- October 18, 2004

## Overview

- Presentation focus = school based obesity prevention programs
- Report results of a literature review conducted to identify effective intervention approaches and features
- Offer suggestions for future directions

##   Why Focus on Schools?

- Over 90% of youth attend school
- Schools offer curricular, PE, and SFS that can be tapped to address the issue
- Social networks exist that can support behavior change
- Established communication channels can be utilized to promote messages
- Longterm interventions can be conducted

## Categories of School-Based Obesity Prevention Programs

- Individual focus
- Curriculum based
- Change individual characteristics
- Focus on behavior – often outside of school
- Environmental focus
- Change school environment – PE, SFS
- Focus on in-school behavior
- Combined focus
- Selected features of both approaches

## What Works?

- Reviewed literature to:
- Determine if programs with an individual, environmental, or combined focus are more likely to be effective in a school-based setting
- Identify differences between programs that achieve change in body composition and those that do not
- Features of successful programs

## Inclusionary Criteria

- Content Criteria
- Focus on diet, physical activity, and/or physical inactivity
- Body composition as dependent variable
- Emphasized prevention, not treatment
- Method Criteria
- Experimental design (randomization)
- School was unit of randomization & analysis
- Appropriate statistical analysis methods

## Results

- Individual Focus
- 8
- 2 changed body composition (25%)
- Environmental Focus
- 2
- 1 changed body composition (50%)
- Combined Focus
- 1
- 0 changed body composition (0%)

## Overview of Findings

- Literature was difficult to summarize or evaluate
- No common convention for reporting results
- Lots of variability in program components and level of detail provided
- Variability in program effect

## Successful Programs 

| AUTHOR | TYPE | FOCUS | GOALS | THEORY | DURATION | IMPLEMENTOR | PARENTS | EFFECT |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| Gortmaker et al 1999

PLANET HEALTH | I | DIET      
PA
PIA |  TV viewing & fat intake

 FV | Behav Choice

SCT | 2 sch years | Trained teachers | Not mentioned | Sig effect,  girls only |
| Robinson  1999 | I | PIA |  physical  
 inactivity. | SCT | 6 mo | Trained teachers | Yes | Sig effect |
| Sallis et al 2003

M-SPAN | E | DIET
PA |  total fat  & sat fat

 energy expend | Cohen’s Structural Ecologic Model | 2 sch years | Trained imple. -  from within school commun. | Yes | Sig effect,  boys only |

**Legend:**
- PA  =  physical activity		I = Individual focus
- PIA  = physical inactivity		 E = Environmental focus

## Successful Programs 

| AUTHOR | TYPE | FOCUS | GOALS | THEORY | DURATION | IMPLEMENTOR | PARENTS | EFFECT |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| Gortmaker et al 1999

PLANET HEALTH | I | DIET      
PA
PIA |  TV viewing & fat intake

 FV | Behav Choice

SCT | 2 sch years | Trained teachers | Not mentioned | Sig effect,  girls only |
| Robinson  1999 | I | PIA |  physical  
 inactivity. | SCT | 6 mo | Trained teachers | Yes | Sig effect |
| Sallis et al 2003

M-SPAN | E | DIET
PA |  total fat  & sat fat

 energy expend | Cohen’s Structural Ecologic Model | 2 sch years | Trained imple. -  from within school commun. | Yes | Sig effect,  boys only |

**Legend:**
- PA  =  physical activity		I = Individual focus
- PIA  = physical inactivity		 E = Environmental focus

## Conclusion

- No conclusions could be drawn regarding:
- Most successful approach in a school setting
- Differences between effective and ineffective interventions

## Recommendation

- Adopt Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) statement
- Provides a standard reporting structure
- Enhances ability to compare diverse studies and to identify effective intervention components

## Where do we go from here?

## Future Directions (1)

- Elucidate effective intervention components
- Conduct single theory/single mechanism research to identify:
- behavior change components most likely to lead to success
- mechanisms that show promise for behavior change
- Understanding single effects more clearly can enhance multi-theoretical approaches

## Example:Food, Fun, & Fitness Club

- 8 wk Internet based program promoting healthy diet and PA behaviors to 8-10 year old African American girls
- Goal
- determine the effect of reinforcement schedule on log on rate, behavior, and mediating variables
- Why important
- log on rate controls dose
- understanding effect of reinforcement schedule on log on rate increases potential for a more effective intervention

## Future Directions (2)

- Refine measurement approach, methods, and tools
- Establish item pools for key variables (IRT)
- Utilize computerized testing to tailor item difficulty to ability (need fewer items)
- Follow common administration protocols to ensure consistency in measurement

## Example:  FJV SE Questionnaire

- Analysis
- CTT – met usual criteria
- IRT – limited item range
- IRT holds promise for:
- Enhancing quality of measurement
- Reduced participant burden
- Example:  Computer Adaptive Testing

## Future Directions (3)

- Critically examine approach to research
- Focus on translational research (e.g., from basic to applied research)

## Example:  Fitness Zone

- Study goal:
- To understand how design features in computer-based interventions impact program effect
- Outcome variables:  PA self efficacy, PA intention, and depth of information processing
- Examines:
- Presentation format (text-based fact sheets vs manga-style comics)
- Processing channel (visual and/or verbal)
- Potential impact:
- Results can be used to design more efficient and effective computer-based interventions

## Concluding Remarks

- Schools provide an important channel for reaching large numbers of youth
- School based obesity prevention programs can achieve change in body composition
- More work is needed to determine the most effective methods for achieving change

## Thank you!