American Journal of Health Promotion

Evaluate the effectiveness of distance physical activity interventions to establish intervention features that are key to success.

Computerized searches for randomized controlled trials (RCTs) of distance physical activity interventions and visual scans of reference lists were performed between March 2004 and July 2006.

Studies were included if they (1) employed a randomized controlled design, (2) encouraged physical activity in adults, and (3) had no face-to-face contact between participants and researchers or health educators.

Twenty-two studies were found that met the inclusion criteria. Authors assessed the quality of the studies and coded articles according to key intervention features.

This review is a systematic narrative review. Heterogeneity and poor study quality made formal meta-analysis inappropriate. Nevertheless, effect sizes were calculated for studies comparing intervention with control.

Overall, distance interventions increased physical activity in the short term (between-group effect size range, −.2 to .45). Print medium plus telephone contact was the most effective delivery mode.

Poor study quality prevented firm conclusions. However, distance interventions were found to promote physical activity in the short term for some populations. This review provided limited support for the efficacy of distance exercise interventions and revealed limitations of the extant literature. Expansion of RCT research into distance approaches to promoting physical activity is warranted.

To test effects of parent/child training designed to increase calcium intake, bone-loading physical activity (PA), and bone density.

Two-group randomized controlled trial.

Family-based intervention delivered at research center.

117 healthy children aged 10–13 years (58.1% female, 42.7% Hispanic, 40.2% White). Ninety-seven percent of participants had at least one parent graduate from high school and 37.2 % had at least one parent graduate from a 4-year university.

Children and parents were randomly assigned to diet and exercise (experimental) or injury prevention (control) interventions. Children were taught in eight weekly classes how to engage in bone-loading PA and eat calcium-rich foods or avoid injuries. Parents were taught behavior management techniques to modify children's behaviors.

Measures at baseline and at 3, 9, and 12 months included 24-hour diet and PA recalls, and bone mineral density (BMD) by dual-energy x-ray absorptiometry.

Analysis of variance and generalized estimating equations (GEE) assessed group by time differences. Comparisons were conducted separately for boys and girls.

For boys, cross-sectional differences between experimental and control groups were achieved for 3- and 9-month calcium intake (1352 vs. 1052 mg/day, 1298 vs. 970 mg/day, p < .05). For girls, marginal cross-sectional differences were achieved for high-impact PA at 12 months (p < .10). For calcium intake, a significant group by time interaction was observed from pretest to posttest for the full sample (p = .008) and for girls (p = .006) but not for boys. No significant group by time differences in calcium were observed across the follow-up period. No group by time differences were observed for high-impact PA. Among boys, longitudinal group by time differences reached significance for total hip BMD (p = .045) and femoral neck BMD (p = .033), even after adjusting for skeletal growth. Similar differential increases were observed among boys for bone mineral content (BMC) at the hip (p = .068) and total body (p = .054) regions. No significant group by time interaction effects were observed for girls at any bone site for BMD. For BMC, control girls showed a significant increase (p = .03) in spine BMC compared to intervention girls.

This study demonstrated that parent/preteen training can increase calcium intake and attenuate the decline in high-impact PA. Results suggest that more powerful interventions are needed to increase activity levels and maximize bone mineral accrual during preadolescent years.

To gather consumer input about approaches to providing energy composition information for foods on fast-food restaurant menus.

We asked a subset of individuals (n = 150) in an experimental study about the influence of nutrition labeling on fast-food meal choices to evaluate calorie information on mock fast-food menus in various formats.

Three community sites in the Minneapolis-St. Paul, Minnesota, metropolitan area.

Adolescents and adults who ate fast food at least once per week were recruited.

Via a series of open- and close-ended questions, participants gave feedback about several formats for providing energy composition information for foods on fast-food restaurant menus.

Means and frequencies were calculated, and χ² tests were conducted.

When asked to compare a menu that provided calorie information for each menu item with a menu that provided the number of minutes of running that would be required to burn the calories contained in each menu item, 71.0% of participants preferred the calorie information over the physical activity information. Participants also compared two approaches to providing caloric reference information on the menu (average daily calorie needs per day vs. per meal), and 61.3% preferred the calorie needs—per-meal format.

Our results may be useful in designing approaches to providing energy composition information for foods on fast-food restaurant menus.

Consumer understanding of nutrition information is key to making dietary choices consistent with guidelines. The development of an objective, science-based, and universally applicable system of nutrition guidance would be of considerable potential value to the public health.

A multidisciplinary expert panel was convened to develop the Overall Nutritional Quality Index (ONQI). Dietary guidelines, existing nutritional scoring systems, and other pertinent scientific literature were reviewed. An algorithm based on the overall nutritional quality of food was developed and subjected to consumer research and validation testing.

The ONQI algorithm incorporates over 30 entries representing both micronutrient and macronutrient properties of foods, as well as weighting coefficients representing epidemiologic associations between nutrients and health outcomes. The basic entry in the algorithm is a weighted trajectory score, which compares nutrient concentration in a food to the recommended concentration of a given nutrient in a healthful diet. In content validity testing, ONQI rankings and expert panel rankings correlated highly (R = .92; p < .001). In regression analysis, aggregated ONQI scores for total diet corresponded well with the Healthy Eating Index (p < .001) in the National Health and Nutrient Examination Survey 2003–2006 cohort (n = 15,900). Consumer research indicated strong appeal to consumers of the ONQI system in general, and the scores on a 1 to 100 scale specifically. A system for acquiring nutrient data, meeting U.S. Food and Drug Administration and U.S. Department of Agriculture standards, has been established so that virtually any food, beverage, meal, or recipe can be scored.

The ONQI is a sophisticated nutrition guidance system developed by a multidisciplinary group independently of all food industry interests with excellent initial performance in both consumer research and validation testing. Combined with a consumer education program, the ONQI has considerable potential to improve dietary patterns, and consequently the public health. Prospective study of effects on dietary patterns and health outcomes is warranted.

To examine associations of the built environment surrounding worksites and of work policies with walking behaviors.

Cross-sectional convenience sample survey.

Workplace.

Employed adults residing in Montgomery County, Maryland.

Four different step measures taken at or near work as recorded using an accelerometer and a fifth measure indicated self-reported walking from work. Participants reported on eight built environment characteristics surrounding the worksite (e.g., the presence of sidewalks, crosswalks, and pedestrian signals) and on four worksite policies (e.g., the presence of exercise facilities and exercise programs).

Cross-sectional associations of self-reported built environment characteristics surrounding worksites and worksite policies with walking behavior were examined.

Although participants reported worksites exhibiting built environment characteristics that were supportive of walking (seven of eight characteristics were reported by >50% of participants), no built environment characteristic was associated with walking more than the median number of average weekday steps (p > .05). All four worksite policies were associated with walking more than the median number of average weekday steps (p < .05). In addition, a perception of few cul-de-sacs and of the presence of litter, sidewalks, crosswalks, and pedestrian signals surrounding the worksites was associated with a higher proportion of participants taking at least one walking trip from work in the past month (p < .05).

Locating worksites in walkable environments and implementing worksite policies may favorably influence employee walking. Future studies should consider a prospective design and examine a larger, more diverse employee population and worksite environment to examine these associations.