Journal of Nutrition Education and Behavior最新文献

Objective: To evaluate potential mediators of weight loss in the Strong Hearts, Health Communities-2.0 (SHHC-2.0) trial.

Design: Community-randomized trial (intervention vs delayed intervention). Outcomes were evaluated at baseline and postintervention.

Setting: Eleven rural, medically-underserved communities PARTICIPANTS: Women (n = 182), mean age 57.2 years, 97.6% White, non-Hispanic.

Intervention: Classes delivered 2 times/wk for 24 weeks, targeting diet and physical activity behaviors.

Main outcomes measures: Dependent variable: weight; mediators: diet and physical activity behaviors, and related psychosocial factors.

Analysis: Mixed linear regressions evaluated the effect of mediators on weight loss.

Results: Significant mediators included dietary behaviors (Rapid Eating Assessment for Participants-Short; 31.8%; P = 0.03), healthy eating attitudes (23.0%; P = 0.03), and dietary cognitive restraint (29.8%; P = 0.01). Physical activity did not mediate weight loss; however, a worsening in attitudes toward exercise was a mediator of weight loss (22.6%; P = 0.01). Social support for diet and physical activity was unchanged in the intervention group and did not mediate weight loss effects.

Conclusions and implications: Healthy eating attitudes and dietary cognitive restraint represent important targets for future behavioral interventions for weight loss. Hypothesized mediators found to be nonsignificant (i.e., social support) represent opportunities for future intervention optimization.

Objective: To develop a machine learning model to identify adult Expanded Food and Nutrition Education Program (EFNEP) participants at high risk of attrition using preprogram data.

Design: Secondary data analysis.

Participants: A total of 339,335 adults participating in EFNEP nationwide from 2013-2022.

Main outcome measures: Adult EFNEP attrition, defined as a participant dropping out of EFNEP before the end of the program.

Analysis: Three machine learning models (logistic regression, random forest, and eXtreme Gradient Boosting) were developed and evaluated to predict attrition based on participants' preprogram food behaviors, dietary intake, demographics, and program characteristics.

Results: The eXtreme Gradient Boosting model demonstrated the best predictive performance, achieving the highest F1 score of 0.68 (a measure of the balance between correctly identifying true dropouts and avoiding false positives), and a recall of 70% (correctly identifying dropouts). Key predictors of attrition included Cooperative Extension region, EFNEP funding tier, enrollment year, household income, age, race, residence, number of children, and preprogram dietary intake and physical activity.

Conclusions and implications: Application of machine learning models in nutrition education program settings can uncover previously unknown patterns contributing to attrition, informing targeted interventions and resource allocation to improve retention and maximize program impact.

Objective: To assess the Food Support Program (Programa de Apoyo Alimentario) implemented by the government of Montevideo to address childhood undernutrition.

Design: A mixed-methods design. Quantitative data were collected through telephone surveys and medical records and analyzed using a prepost design. Qualitative data were collected through interviews with mothers of beneficiary children.

Setting: Montevideo, Uruguay.

Participants: A total of 120 children participants of the Food Support Program and their mothers.

Main outcome measures: Household food insecurity, children's food consumption frequency of 17 categories in the week before the survey, anthropometric data (weight-for-age, length-for-age, and weight-for-length z-scores), and mothers' perceptions about the program.

Analysis: Mixed linear models and content analysis of interviews.

Results: Average household food insecurity score decreased by 1.5 points (P < 0.001) after 12 months. Average frequency of milk and cheese consumption increased by 1.3 days (P < 0.001), frequency of adding oil to meals by 1.0 days (P = 0.002), and consumption frequency of sugary foods by 1.4 days (P < 0.001). Average z-scores for weight-for-age and weight-for-length increased 0.37 (P < 0.001) and 0.31 (P = 0.001), respectively. However, length-for-age showed no significant change (P = 0.90). Mothers of beneficiary children valued economic support but highlighted gaps in program communication and education, and counseling activities.

Conclusions and implications: The program showed potential to alleviate immediate nutritional deficiencies, but additional and sustained integrated efforts are needed to address chronic undernutrition, food insecurity, and diet quality. In particular, the persistence of food insecurity in half of the households after 12 months underscores the need to reassess the adequacy of the cash transfer amount relative to the affordability of a healthy food basket in the country.