title: The Effectiveness of Tailored Feedback and Action Plans in an Intervention Addressing Multiple Health Behaviors Eating the elephant whole or in slices: views of participants in a smoking cessation intervention trial on multiple behaviour changes as sequential or concurrent tasks Combined effect of health behaviours and risk of first ever stroke in 20 040 men and women over 11 years’ follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods Improving women's preconceptional health: long-term effects of the Strong Healthy Women behavior change intervention in the central Pennsylvania Women's Health Study. Tailored Print Communication and Telephone Motivational Interviewing Are Equally Successful in Improving Multiple Lifestyle Behaviors in a Randomized Controlled Trial Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial Physical activity and nutrition behavioural outcomes of a home-based intervention program for seniors: a randomized controlled trial Effects of a Web-Based Tailored Multiple-Lifestyle Intervention for Adults: A Two-Year Randomized Controlled Trial Comparing Sequential and Simultaneous Delivery Modes Efficacy of exercise counselling as an aid for smoking cessation: a randomized controlled trial. Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial. Systematic reviews of health effects of social interventions: 2. Best available evidence: how low should you go? Cluster randomised trial of the effectiveness of motivational interviewing for universal prevention. Effectiveness of a Home-Based Postal and Telephone Physical Activity and Nutrition Pilot Program for Seniors Changes in body weight and food choice in those attempting smoking cessation: a cluster randomised controlled trial Brief multiple behavior interventions in a college student health care clinic. Project Joy: Faith Based Cardiovascular Health Promotion for African American Women Automated interventions for multiple health behaviors using conversational agents. Development and evaluation of an HIV-risk reduction program for female college students. Results of the healthy body healthy spirit trial. A community-based health promotion intervention using brief negotiation techniques and a pledge on dietary intake, physical activity levels and weight outcomes: lessons learnt from an exploratory trial. A randomized trial of sequential and simultaneous multiple behavior change interventions for physical activity and fat intake. The Efficacy of an HIV Risk Reduction Intervention for Hispanic Women Improving multiple behaviors for colorectal cancer prevention among african american church members. Randomized trial of a clinic-based, community-supported, lifestyle intervention to improve physical activity and diet: the North Carolina enhanced WISEWOMAN project. Provider counseling, health education, and community health workers: the Arizona WISEWOMAN project. The Faith, Activity, and Nutrition program: a randomized controlled trial in African-American churches. Are effects from a brief multiple behavior intervention for college students sustained over time?
abstract: Purpose . Examine the effects of three iterative tailored feedback letters addressing smoking ; physical activity ; and fruit , vegetable , and fat intake , and test the additional effects of providing feedback on action plans . Design . A tailored , print-based intervention was developed and tested in a r and omized control trial with a posttest after 9 months . Setting . A total of 2827 respondents agreed to participate . They were recruited from a r and om sample of 35,000 addresses obtained through the Dutch national telephone company . Subjects . The mean age was 49 years , and 55 % were female . Intervention . The experimental group received three printed tailored letters , and the control group received three printed generic letters . Respondents from the experimental group r and omly received either a third letter with tailored information or tailored information and action-planning feedback . Measures . The question naire assessed physical activity ; smoking ; consumption of fruit , vegetables and fat ; motivational determinants ; action plans ; and demographics . Results . Tailored information result ed in more improvement over time than generic information for the intake of fruit , vegetables , and fat and for physical activity . No differences between the conditions were found for smoking because of high cessation rates in all conditions . Action-planning feedback did not increase the effects . Conclusions . Tailored lifestyle information can be effective for adults in changing nutrition behavior and physical activity Background This paper explores smoking cessation participants ’ perceptions of attempting weight management alongside smoking cessation within the context of a  health improvement intervention implemented in Glasgow , Scotl and . Methods One hundred and thirty-eight participants were recruited from smoking cessation classes in areas of multiple deprivation in Glasgow and r and omised to intervention , receiving dietary advice , or to control groups .  The primary outcome of the study was to determine the % change in body weight . Semi-structured interviews were conducted with a purposive sample of 15 intervention and 15 control participants at weeks 6 ( during the intervention ) and 24 ( at the end of the intervention ) . The current paper , though predominantly qualitative , links perceptions of behaviour modification to % weight change and cessation rates at week 24 thereby enabling a better underst and ing of the mediators influencing multiple behaviour change . Results Our findings suggest that participants who perceive separate behaviour changes as part of a broader approach to a healthier lifestyle , and hence attempt behaviour changes concurrently , may be at comparative advantage in positively achieving dual outcomes . Conclusions These findings highlight the need to assess participants ’ preference for attempting multiple behaviour changes sequentially or simultaneously in addition to assessing their readiness to change . Further testing of this hypothesis is warranted . Trial Registration IS RCT Objective To quantify the potential combined impact of four health behaviours on incidence of stroke in men and women living in the general community . Design Population based prospect i ve study ( EPIC-Norfolk ) . Setting Norfolk , United Kingdom . Participants 20 040 men and women aged 40 - 79 with no known stroke or myocardial infa rct ion at baseline survey in 1993 - 7 , living in the general community , and followed up to 2007 . Main outcome measure Participants scored one point for each health behaviour : current non-smoking , physically not inactive , moderate alcohol intake ( 1 - 14 units a week ) , and plasma concentration of vitamin C ≥50 µmol/l , indicating fruit and vegetable intake of at least five servings a day , for a total score ranging from 0 to 4 . Results There were 599 incident strokes over 229 993 person years of follow-up ; the average follow-up was 11.5 years . After adjustment for age , sex , body mass index ( BMI ) , systolic blood pressure , cholesterol concentration , history of diabetes and aspirin use , and social class , compared with people with the four health behaviours the relative risks for stroke for men and women were 1.15 ( 95 % confidence interval 0.89 to 1.49 ) for three health behaviours , 1.58 ( 1.22 to 2.05 ) for two , 2.18 ( 1.63 to 2.92 ) for one , and 2.31 ( 1.33 to 4.02 ) for none ( P<0.001 for trend ) . The relations were consistent in subgroups stratified by sex , age , body mass index , and social class , and after exclusion of deaths within two years . Conclusion Four health behaviours combined predict more than a twofold difference in incidence of stroke in men and women Background We report the main results , among adults , of a cluster-r and omised-trial of Well London , a community-engagement programme  promoting healthy eating , physical activity and mental well-being in deprived neighbourhoods . The hypothesis was that benefits would be neighbourhood-wide , and not restricted to intervention participants . The trial was part of a multicomponent process/ outcome evaluation which included non-experimental components ( self-reported behaviour change amongst participants , case studies and evaluations of individual projects ) which suggested health , well-being and social benefits to participants . Methods Twenty matched pairs of neighbourhoods in London were r and omised to intervention/control condition . Primary outcomes ( five portions fruit/vegetables/day ; 5 × 30 m of moderate intensity physical activity/week , abnormal General Health Question naire (GHQ)-12 score and Warwick – Edinburgh Mental Well-being Scale ( WEMWBS ) score ) were measured by postintervention question naire survey , among 3986 adults in a r and om sample of households across neighbourhoods . Results There was no evidence of impact on primary outcomes : healthy eating ( relative risk [ RR ] 1.04 , 95 % CI 0.93 to 1.17 ) ; physical activity ( RR:1.01 , 95 % CI 0.88 to 1.16 ) ; abnormal GHQ12 ( RR:1.15 , 95 % CI 0.84 to 1.61 ) ; WEMWBS ( mean difference [ MD ] : −1.52 , 95 % CI −3.93 to 0.88 ) . There was evidence of impact on some secondary outcomes : reducing unhealthy eating-score ( MD : −0.14 , 95 % CI −0.02 to 0.27 ) and increased perception that people in the neighbourhood pulled together ( RR : 1.92 , 95 % CI 1.12 to 3.29 ) . Conclusions The trial findings do not provide evidence supporting the conclusion of non-experimental components of the evaluation that intervention improved health behaviours , well-being and social outcomes . Low participation rates and population churn likely compromised any impact of the intervention . Imprecise estimation of outcomes and sampling bias may also have influenced findings . There is a need for greater investment in refining such programmes before implementation ; new methods to underst and , longitudinally different pathways residents take through such interventions and their outcomes , and new theories of change that apply to each pathway PURPOSE To investigate the long-term ( 6- and 12-month ) effects of the Strong Healthy Women intervention on health-related behaviors , weight and body mass index ( BMI ) , and weight gain during pregnancy .  Strong Healthy Women is a small-group behavioral intervention for pre- and interconceptional women design ed to modify key risk factors for adverse pregnancy outcomes ; pretest-posttest findings from a r and omized , controlled trial have been previously reported . The following questions are addressed : 1 ) were significant pretest-posttest changes in health-related behaviors ( previously reported ) maintained over the 12-month follow-up period ; 2 ) did the intervention impact weight and BMI over the 12-month follow-up period ; and 3 ) did the intervention impact pregnancy weight gain for those who gave birth during the follow-up period ? METHODS Data are from 6- and 12-month follow-up telephone interviews of women in the original trial of the Strong Healthy Women intervention ( n = 362 ) and from birth records for singleton births ( n = 45 ) during the 12-month follow-up period . Repeated measures regression was used to evaluate intervention effects . MAIN FINDINGS At the 12-month follow-up , participants in the Strong Healthy Women intervention were significantly more likely than controls to use a daily multivitamin with folic acid and to have lower weight and BMI . The intervention 's effect on reading food labels for nutritional values dropped off between the 6- and 12-month follow-up . Among those who gave birth to singletons during the follow-up period , women who participated in the intervention had lower average pregnancy weight gain compared with controls . Although the intervention effect was no longer significant when controlling for pre-pregnancy obesity , the adjusted means show a trend toward lower weight gain in the intervention group . CONCLUSION These findings provide important evidence that the Strong Healthy Women behavior change intervention is effective in modifying important risk factors for adverse pregnancy outcomes and may improve an important pregnancy outcome , weight gain during pregnancy . Because the intervention seems to help women manage their weight in the months after the intervention and during pregnancy , it may be an effective obesity prevention strategy for women before , during , and after the transition to motherhood Background Computer tailoring and motivational interviewing show promise in promoting lifestyle change , despite few head-to-head comparative studies . Purpose Vitalum is a r and omized controlled trial in which the efficacy of these methods was compared in changing physical activity and fruit and vegetable consumption in middle-aged Dutch adults . Methods Participants ( n = 1,629 ) were recruited via 23 general practice s and r and omly received either four tailored print letters , four motivational telephone calls , two of each type of intervention , or no information . The primary outcomes were absolute change in self-reported physical activity and fruit and vegetable consumption . Results All three intervention groups ( i.e. , the tailored letters , the motivational calls , and the combined version ) were equally and significantly more effective than the control group in increasing physical activity ( hours/day ) , intake of fruit ( servings/day ) , and consumption of vegetables ( grams/day ) from baseline to the intermediate measurement ( week 25 ) , follow-up 1 ( week 47 ) and 2 ( week 73 ) . Effect sizes ( Cohen ’s d ) ranged from 0.15 to 0.18 . Participants rated the interventions positively ; interviews were more positively evaluated than letters . Conclusions Tailored print communication and telephone motivational interviewing or their combination are equally successful in changing multiple behaviors Background Few studies have evaluated how to combine dietary and physical activity ( PA ) interventions to enhance adherence . Purpose We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes . Methods Two hundred participants over age 44 years not meeting national PA and dietary recommendations ( daily fruit and vegetable servings and percent of calories from saturated fat ) were r and omized to one of four 12-month telephone interventions : sequential ( exercise first or diet first ) , simultaneous , or attention control . At 4 months , the other health behavior was added in the sequential arms . Results Ninety-three percent of participants were retained through 12 months . At 4 months , only exercise first improved PA , and only the simultaneous and diet-first interventions  improved dietary variables . At 12 months , mean levels of all behaviors in the simultaneous arm met recommendations , though not in the exercise- and diet-first arms . Conclusions We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation Background This intervention aim ed to ascertain whether a low-cost , accessible , physical activity and nutrition program could improve physical activity and nutrition behaviours of insufficiently active 60–70 year olds residing in Perth , Australia . Methods A 6-month home-based r and omised controlled trial was conducted on 478 older adults ( intervention , n = 248 ; control , n = 230 ) of low to medium socioeconomic status . Both intervention and control groups completed postal question naires at baseline and post-program , but only the intervention participants received project material s. A modified fat and fibre question naire measured nutritional behaviours , whereas  physical activity was measured using the International Physical Activity Question naire . Generalised estimating equation models were used to assess the repeated outcomes over both time points . Results The final sample consisted of 176 intervention participants and 199 controls ( response rate 78.5 % ) with complete data . After controlling for demographic and other confounding factors , the intervention group demonstrated increased participation in strength exercise ( p < 0.001 ) , walking ( p = 0.029 ) and vigorous activity ( p = 0.015 ) , together with significant reduction in mean sitting time ( p < 0.001 ) relative to controls . Improvements in nutritional behaviours for the intervention group were also evident in terms of fat avoidance ( p < 0.001 ) , fat intake ( p = 0.021 ) and prevalence of frequent fruit intake ( p = 0.008 ) . Conclusions A minimal contact , low-cost and home-based physical activity program can positively influence seniors ’ physical activity and nutrition behaviours . Trial registration anzctr.org.au Identifier : Background Web-based computer-tailored interventions for multiple health behaviors can have a significant public health impact . Yet , few r and omized controlled trials have tested this assumption . Objective The objective of this paper was to test the effects of a sequential and simultaneous Web-based tailored intervention on  multiple lifestyle behaviors . Methods A r and omized controlled trial was conducted with 3 tailoring conditions ( ie , sequential , simultaneous , and control conditions ) in the Netherl and s in 2009 - 2012 . Follow-up measurements took place after 12 and 24 months . The intervention content was based on the I-Change model . In a health risk appraisal , all respondents ( N=5055 )  received feedback on their lifestyle behaviors that indicated whether they complied with the Dutch guidelines for physical activity , vegetable consumption , fruit consumption , alcohol intake , and smoking .  Participants in the sequential ( n=1736 ) and simultaneous ( n=1638 ) conditions received tailored motivational feedback to change unhealthy behaviors one at a time ( sequential ) or all at the same time ( simultaneous ) . Mixed model analyses were performed as primary analyses ; regression analyses were done as sensitivity analyses . An overall risk score was used as outcome measure , then effects on the 5 individual lifestyle behaviors were assessed and a process evaluation was performed regarding exposure to and appreciation of the intervention . Results Both tailoring strategies were associated with small self-reported behavioral changes . The sequential condition had the most significant effects compared to the control condition after 12 months ( T1 , effect size=0.28 ) . After 24 months ( T2 ) , the simultaneous condition was most effective ( effect size=0.18 ) . All 5 individual lifestyle behaviors changed over time , but few effects differed significantly between the conditions . At both follow-ups , the sequential condition had significant changes in smoking abstinence compared to the simultaneous condition ( T1 effect size=0.31 ; T2 effect size=0.41 ) . The sequential condition was more effective in decreasing alcohol consumption than the control condition at 24 months ( effect size=0.27 ) . Change was predicted by the amount of exposure to the intervention ( total visiting time : beta=–.06 ; P=.01 ; total number of visits : beta=–.11 ; P<.001 ) . Both interventions were appreciated well by respondents without significant differences between conditions . Conclusions Although evidence was found for the effectiveness of both programs , no simple conclusive finding could be drawn about which intervention mode was more effective . The best kind of intervention may depend on the behavior that is targeted or on personal preferences and motivation . Further research is needed to identify moderators of intervention effectiveness . The results need to be interpreted in view of the high and selective dropout rates , multiple comparisons , and modest effect sizes . However , a large number of people were reached at low cost and behavioral change was achieved after 2 years . Trial Registration Nederl and s Trial Register : NTR 2168 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2168 ( Archived by WebCite at http://www.webcitation.org/6MbUqttYB ) AIM To examine whether exercise counselling increases smoking abstinence and reduces tobacco withdrawal and gains in weight and body fat . DESIGN A r and omized controlled trial . SETTING A community-based stop smoking clinic . PARTICIPANTS Two hundred and ninety-nine male and female smokers . INTERVENTION Participants were assigned r and omly to a 7-week smoking cessation programme , including nicotine replacement therapy plus either ( i ) exercise counselling , or ( ii ) health education advice with equal contact time as for the exercise counselling condition . MEASUREMENTS Six weeks of smoking abstinence was confirmed by expired carbon monoxide . FINDINGS There was no significant difference in smoking abstinence between the exercise group ( n = 154 ) and the controls ( n = 145 ) at 6 weeks ( 39.6 % versus 38.6 % ) , nor was there any difference in gains in weight or body fat , although those in the exercise group increased their exercise levels . Exercise participants reported less tension , anxiety and stress than the controls during the first week of smoking abstinence ( P = 0.03 , 0.01 and 0.04 , respectively ) , less irritability throughout 2 weeks of abstinence ( P = 0.03 ) , and less restlessness throughout 3 weeks of abstinence ( P = 0.04 ) . CONCLUSIONS Adding brief exercise counselling to a smoking cessation programme did not increase smoking abstinence or reduce gains in weight or body fat significantly , although exercise levels were raised and there were some beneficial effects on psychological symptoms OBJECTIVE To determine if an interactive , computerized Video Doctor counseling tool improves self-reported diet and exercise in pregnant women . METHODS A r and omized trial comparing a Video Doctor intervention to usual care in ethnically diverse , low-income , English-speaking pregnant women was conducted . Brief messages about diet , exercise , and weight gain were delivered by an actor-portrayed Video Doctor twice during pregnancy . RESULTS In the  Video Doctor group ( n=158 ) , there were statistically significant increases from baseline in exercise ( + 28 min ) , intake of fruits and vegetables , whole grains , fish , avocado and nuts , and significant decreases in intake of sugary foods , refined grains , high fat meats , fried foods , solid fats , and fast food . In contrast , there were no changes from baseline for any of these outcomes in the usual care group ( n=163 ) . Nutrition knowledge improved significantly over time in both groups but more so in the Video Doctor group . Clinician-patient discussion s about these topics occurred significantly more frequently in the Video Doctor group . There was no difference in weight gain between groups . CONCLUSION A brief Video Doctor intervention can improve exercise and dietary behaviors in pregnant women . PRACTICE IMPLICATION S The Video Doctor can be integrated into prenatal care to assist clinicians with effective diet and exercise counseling Study objective : There is little guidance on how to select the best available evidence of health effects of social interventions . The aim of this paper was to assess the implication s of setting particular inclusion criteria for evidence synthesis . Design : Analysis of all relevant studies for one systematic review , followed by sensitivity analysis of the effects of selecting studies based on a two dimensional hierarchy of study design and study population . Setting : Case study of a systematic review of the effectiveness of interventions in promoting a population shift from using cars towards walking and cycling .  Main results : The distribution of available evidence was skewed . Population level interventions were less likely than individual level interventions to have been studied using the most rigorous study design s ; nearly all of the population level evidence would have been missed if only r and omised controlled trials had been included . Examining the studies that were excluded did not change the overall conclusions about effectiveness , but did identify additional categories of intervention such as health walks and parking charges that merit further research , and provided evidence to challenge assumptions about the actual effects of progressive urban transport policies . Conclusions : Unthinking adherence to a hierarchy of study design as a means of selecting studies may reduce the value of evidence synthesis and reinforce an “ inverse evidence law ” whereby the least is known about the effects of interventions most likely to influence whole population s. Producing generalisable estimates of effect sizes is only one possible objective of evidence synthesis . Mapping the available evidence and uncertainty about effects may also be important BACKGROUND The prevention of initiation of tobacco , alcohol and drug use is a major societal challenge , for which the existing research literature is generally disappointing . This study aim ed to test the effectiveness of adaptation of Motivational Interviewing ( MI ) for universal prevention purpose s , i.e. to prevent initiation of new substance use among non-users , and to reduce risks among existing users . METHODS Cluster r and omised trial with 416 students aged 16 - 19 years old recruited in 12 London Further Education colleges without regard to substance use status .  Individualised MI was compared with st and ard practice classroom-delivered Drug Awareness intervention , both delivered over the course of one lesson . Prevalence , initiation and cessation rates for the 3 target behaviours of cigarette smoking , alcohol consumption and cannabis use , along with reductions in use and harm indicators after both 3 and 12 months were assessed . RESULTS This adaptation of MI was not demonstrated to be effective in either intention-to-treat or sub-group analyses for any outcome . Unexpected lower levels of cannabis initiation and prevalence were found in the Drug Awareness control condition . CONCLUSIONS This particular adaptation of MI is ineffective as a universal drug prevention intervention and does not merit further study Objective . To evaluate the effectiveness of a 12-week home-based postal and telephone physical activity and nutrition pilot program for seniors . Methods . The program was delivered by mailed material and telephone calls . The main intervention consisted of a booklet tailored for seniors containing information on dietary guidelines , recommended physical activity levels , and goal setting . Dietary and walking activity outcomes were collected via a self-administered postal question naire pre- and postintervention and analysed using linear mixed regressions . Of the 270 seniors recruited , half were r and omly selected for the program while others served as the control group . Results . The program elicited favourable responses . Postintervention walking for exercise/recreation showed an average gain of 27 minutes per week for the participants in contrast to an average drop of 5 minutes for the controls ( P < .01 ) . Little change was evident in err and walking for both groups . The intervention group ( n = 114 ) demonstrated a significant increase in fibre intake ( P < .01 ) but no reduction in fat intake ( P > .05 ) compared to controls ( n = 134 ) . Conclusions . The participants became more aware of their health and wellbeing after the pilot program , which was successful in increasing time spent walking for recreation and improving fibre intake Background Fear of weight gain is a barrier to smoking cessation and significant cause of relapse for many people . The provision of nutritional advice as part of a smoking cessation programme may assist some in smoking cessation and perhaps limit weight gain . The aim of this study was to determine the effect of a structured programme of dietary advice on weight change and food choice , in adults attempting smoking cessation . Methods Cluster r and omised controlled design . Classes r and omised to intervention commenced a 24-week intervention , focussed on improving food choice and minimising weight gain .  Classes r and omised to control received “ usual care ” . Results Twenty-seven classes in Greater Glasgow were r and omised between January and August 2008 . Analysis , including those who continued to smoke , showed that actual weight gain and percentage weight gain was similar in both groups . Examination of data for those successful at giving up smoking showed greater mean weight gain in intervention subjects ( 3.9 ( SD 3.1 ) vs. 2.7 ( SD 3.7 ) kg ) . Between group differences were not significant ( p = 0.23 , 95 % CI −0.9 to 3.5 ) . In comparison to baseline improved consumption of fruit and vegetables and breakfast cereal were reported in the intervention group . A higher percentage of control participants continued smoking ( 74 % vs. 66 % ) . Conclusions The intervention was not successful at minimising weight gain in comparison to control but was successful in facilitating some sustained improvements in the dietary habits of intervention participants . Improved quit rates in the intervention group suggest that continued contact with advisors may have reduced anxieties regarding weight gain and encouraged cessation despite weight gain . Research should continue in this area as evidence suggests that the negative effects of obesity could outweigh the health benefits achieved through reductions in smoking prevalence . Trial registration Current Controlled Trials IS RCT PURPOSE This study examined the effects of brief image-based interventions , including a multiple behavior health contract , a one-on-one tailored consultation , and a combined consultation plus contract intervention , for impacting multiple health behaviors of students in a university health clinic . METHODS A total of 155 college students attending a major southern university were recruited to participate in a study evaluating a health promotion program titled Project Fitness during the fall 2005 and spring 2006 . Participants were r and omly assigned to one of three treatments as they presented at the clinic : 1 ) a multiple behavior health contract , 2 ) a one-on-one tailored consultation , or 3 ) a combined consultation plus contract intervention . Baseline and 1-month post-intervention data were collected using computer-assisted question naires in a quiet office within the student health clinic . RESULTS Omnibus repeated- measures analyses of variance were significant for drinking driving behaviors , F(2,136 ) = 4.43 , p = .01 , exercise behaviors , F(5,140 ) = 6.12 , p = .00 , nutrition habits , F(3,143 ) = 5.37 , p = .00 , sleep habits , F(2,144 ) = 5.03 , p = .01 , and health quality of life , F(5,140 ) = 3.09 , p = .01 , with improvements on each behavior across time . Analysis of group-by-time interaction effects showed an increase in the use of techniques to manage stress , F(2,144 ) = 5.48 , p = .01 , and the number of health behavior goals set in the last 30 days , F(2,143 ) = 5.35 , p = .01 , but only among adolescents receiving the consultation , or consultation plus contract .  Effect sizes were consistently larger across health behaviors , and medium in size , when both consult and contract were used together . CONCLUSIONS Brief interventions using a positive goal image of fitness , and addressing a number of health habits using a contract and consultation strategy alone , or in combination , have the potential to influence positive changes in multiple health behaviors of college students attending a university primary health care clinic Objective . The authors tested the impact on cardiovascular risk profiles of African American women ages 40 years and older after one year of participation in one of three church-based nutrition and physical activity strategies : a st and ard behavioral group intervention , the st and ard intervention supplemented with spiritual strategies , or self-help strategies . Methods . Women were screened at baseline and after one year of participation . The authors analyzed intention-to-treat within group and between groups using a generalized estimating equations adjustment for intra-church clustering . Because spiritual strategies were added to the st and ard intervention by participants themselves , the results from both active groups were similar and , thus , combined for comparisons with the self-help group . Results . A total of 529 women from 16 churches enrolled . Intervention participants exhibited significant improvements in body weight ( −1.1 lbs ) , waist circumference ( −0.66 inches ) , systolic blood pressure ( −1.6 mmHg ) , dietary energy ( −117 kcal ) , dietary total fat ( −8 g ) , and sodium intake ( −145 mg ) . The self-help group did not . In the active intervention group , women in the top decile for weight loss at one year had even larger , clinical ly meaningful changes in risk outcomes ( −19.8 lbs ) . Conclusions . Intervention participants achieved clinical ly important improvements in cardiovascular disease risk profiles one year after program initiation , which did not occur in the self-help group . Church-based interventions can significantly benefit the cardiovascular health of African American women OBJECTIVE An automated health counselor agent was design ed to promote both physical activity and fruit and vegetable consumption through a series of simulated conversations with users on their home computers . METHODS The agent was evaluated in a 4-arm r and omized trial of a two-month daily contact intervention comparing : ( a )  physical activity ;  ( b )  fruit and vegetable consumption ; ( c ) both interventions ; and ( d ) a non-intervention control .  Physical activity was assessed using daily pedometer steps . Daily servings of fruit and vegetables were assessed using the NIH/NCI self-report Fruit and Vegetable Scan . RESULTS Participants in the physical activity intervention increased their walking on average compared to the control group , while those in the fruit and vegetable intervention and combined intervention decreased walking . Participants in the fruit and vegetable intervention group consumed significantly more servings per day compared to those in the control group , and those in the combined intervention reported consuming more compared to those in the control group . CONCLUSION Automated health intervention software design ed for efficient re-use is effective at changing health behavior . PRACTICE IMPLICATION S Automated health behavior change interventions can be design ed to facilitate translation and adaptation across multiple behaviors College students are engaging in high rates of behavior related to risk of infection from Human Immunodeficiency Virus ( HIV ) and other sexually transmitted diseases ( STDs ) . A cognitive-behavioral skills training program for heterosexual college females focused on sexual assertiveness skills and the reduction of risk-related behaviors was design ed and evaluated compared with an education-only program . Participants completed pre-intervention , post-intervention , and one-month follow-up assessment s of : ( a ) HIV/STD-related knowledge and beliefs ; ( b ) sexual , alcohol , and drug-related behaviors ; and ( c ) sexual assertiveness role-plays . Skills training participants compared to education-only participants scored higher on sexual assertiveness skills , specific knowledge of HIV infection , and self-efficacy to perform lower risk sexual behaviors and reported a reduction in risk-related behaviors at post-intervention and follow-up assessment s. The effectiveness of behavioral skills in HIV risk-reduction programs for college students is discussed Healthy Body Healthy Spirit was a multicomponent intervention to increase fruit and vegetable ( F & V ) consumption and  physical activity ( PA )  delivered through Black churches . Sixteen churches were r and omly assigned to 3 intervention conditions . At baseline , 1,056 individuals were recruited across the 16 churches , of which 906 ( 86 % ) were assessed at 1-year follow-up . Group 1 received st and ard educational material s , Group 2 received culturally targeted self-help nutrition and PA material s , and Group 3 received the same intervention as did Group 2 as well as 4 telephone counseling calls based on motivational interviewing ( MI ) delivered over the course of 1 year . At 1-year follow-up , Groups 2 and 3 showed significant changes in both F & V intake and PA . Changes were somewhat larger for F & V. For F & V , but not PA , there was a clear additive effect for the MI intervention OBJECTIVE To assess the effectiveness of a brief face-to-face health promotion intervention which included a ' pledge ' using brief negotiation techniques , compared with st and ard advice-giving techniques , delivered in a community setting . DESIGN A parallel group pre-post design using r and omised matched groups . Lifestyle helpers delivered the intervention ( one consultation per participant ) . Diet , physical activity and anthropometric measurements were collected at baseline , 6 months and 12 months . Qualitative data were also collected . SETTING Middlesbrough ( UK ) . SUBJECTS Adults living in low socio-economic areas . RESULTS Recruitment and engagement of lifestyle helpers was difficult , and initial expectations that local health authority staff working in the community and community champions would act as lifestyle helpers were not realised . As a consequence , recruitment of participants was lower than anticipated . One hundred and twenty-eight adults were recruited and the retention rate was 48 % at 12 months . Barriers to participation included poor health and competing commitments . No significant differences in change in diet or physical activity behaviours , or BMI , between the intervention and control groups were observed . The control group had a significantly greater decrease in waist circumference at 12 months compared with the intervention group . CONCLUSIONS This exploratory trial provides important insights in terms of recruiting lifestyle helpers for community-based health promotion interventions , specifically ( i ) the priorities and limitations in terms of time ( regardless of their general enthusiasm ) for staff employed by the local health authority , and ( ii ) the willingness of potential community champions to serve their local community in areas where community identity and ' spirit ' are seen as lacking BACKGROUND Major questions remain unanswered about how best to accomplish multiple behavior change . The purpose of this study was to evaluate whether there are differences in successfully changing multiple behaviors in computer-tailored sequential and simultaneous interventions for physical activity ( PA ) promotion and fat intake ( FI ) reduction . METHODS Participants ( N=567 ) were r and omly assigned to receive an intervention for PA and FI simultaneously ; PA at baseline and FI at 3 months ; or FI at baseline and PA at 3 months .  Successful behavior change at 6 months was defined as : > 60 min PA increase and /or 5 % FI reduction . Using multinomial logistic regression the odds ratios of successful behaviors change ( none , PA only , FI only , or both ) were determined for intervention mode , gender , age , BMI and education . RESULTS Overall drop-out was 26 % . There was no behavior change for 20.2 % of participants ; 30.5 % successfully decreased FI ; 15.8 % successfully increased PA ; 33.5 % successfully changed both behaviors . Intervention mode , gender and age were not associated with successful behavior change . Compared to those that did not change any behaviors : participants that successfully changed FI were more likely to be overweight/obese ( OR=1.85 ) ; and participants that successfully changed both behaviors were more likely to be overweight/obese ( OR=2.13 ) and have lower education ( OR=2.46 ) . CONCLUSIONS Success in changing multiple behaviors was not associated with intervention mode ; both simultaneous and sequential interventions can be applied . Being overweight might be an extra motivator to change health behaviors Culturally-specific  HIV risk reduction interventions for Hispanic women are needed . SEPA ( Salud/Health , Educación/Education , Promoción/Promotion , y/ and Autocuidado/Self-care ) is a culturally-specific and theoretically-based group intervention for Hispanic women . The SEPA intervention consists of five sessions covering STI and HIV prevention ; communication , condom negotiation  and  condom use  ; and  violence prevention .  A r and omized trial tested the efficacy of SEPA with 548 adult U.S. Hispanic women ( SEPA n = 274 ; delayed intervention control n = 274 ) who completed structured interviews at baseline and 3 , 6 , and 12 months post-baseline . Intent-to-treat analyses indicated that SEPA decreased positive urine sample s for Chlamydia ; improved condom use , decreased substance abuse and IPV ; improved communication with partner , improved HIV-related knowledge , improved intentions to use condoms , decreased barriers to condom use , and increased community prevention attitudes . Culturally-specific interventions have promise for preventing HIV for Hispanic women in the U.S. The effectiveness of SEPA should be tested in a translational community trial . ResumenIntervenciones culturalmente específicas son necesarias para la reducción de riesgo de contraer VIH en las mujeres hispanas .  SEPA ( Salud/Health , Educación/Education , Promoción/Promotion , y Autocuidado/Self-care ) es una intervención grupal culturalmente específica con bases teóricas diseñada para mujeres Hispanas . La intervención SEPA consiste en cinco sesiones que cubren temas relacionados con la prevención de ITS - VIH , comunicación , negociación y uso del condón ; y prevención de la violencia . Utiliz and o un estudio r and omizado se probó la eficacia de SEPA con una muestra de 548 mujeres hispanas que viven en los Estados Unidos de Norteamérica ( SEPA n = 274 ; grupo control n = 274 ) . Las participantes respondieron una entrevistas estructuradas al inicio del estudio y a los 3 , 6 , y 12 meses posteriores a la intervención . Los result ados del análisis señalan que las mujeres que participaron en SEPA disminuyeron las muestras positivas de Chlamydia en orina , aumentaron el uso del condón , disminuyeron el abuso de sustancias y los episodios de violencia de pareja , mejoraron la comunicación de pareja , aumentaron el conocimiento sobre VIH , mejoraron la intención de utilizar condón , percibieron menores barreras para uso del condón , y mejoraron las actividades de prevención en la comunidad . Las intervenciones culturalmente específicas son promisorias para la prevención del VIH en las mujeres hispanas que viven en los Estados Unidos de Norteamérica . La efectividad de SEPA debe ser probada en la comunidad The WATCH ( Wellness for African Americans Through Churches ) Project was a r and omized trial comparing the effectiveness of 2 strategies to promote colorectal cancer preventive behaviors among 587 African American members of 12 rural North Carolina churches . Using a 2 X 2 factorial research design , the authors compared a tailored print and video ( TPV ) intervention , consisting of 4 individually tailored newsletters and targeted videotapes , with a lay health advisor ( LHA ) intervention . Results showed that the TPV intervention significantly improved ( p < .05 ) fruit and vegetable consumption ( 0.6 servings ) and recreational physical activity ( 2.5 metabolic task equivalents per hour ) and , among those 50 and older ( n = 287 ) , achieved a 15 % increase in fecal occult blood testing screening ( p = .08 ) . The LHA intervention did not prove effective , possibly because of suboptimal reach and diffusion OBJECTIVE To determine if a clinic-based behavioral intervention program for low-income mid-life women that emphasizes use of community re sources will increase moderate intensity physical activity ( PA ) and improve dietary intake . METHODS R and omized trial conducted from May 2003 to December 2004 at one community health center in Wilmington , NC . A total of 236 women , ages 40 - 64 , were r and omized to receive an Enhanced Intervention ( EI ) or Minimal Intervention ( MI ) . The EI consisted of an intensive phase ( 6 months ) including 2 individual counseling sessions , 3 group sessions , and 3 phone calls from a peer counselor followed by a maintenance phase ( 6 months ) including 1 individual counseling session and 7 monthly peer counselor calls . Both phases included efforts to increase participants ' use of community re sources that promote positive lifestyle change . The MI consisted of a one-time mailing of pamphlets on diet and PA . Outcomes , measured at 6 and 12 months , included the comparison of moderate intensity PA between study groups as assessed by accelerometer ( primary outcome ) and question naire , and dietary intake assessed by question naire and serum carotenoids ( 6 months only ) . RESULTS For accelerometer outcomes , follow-up was 75 % at 6 months and 73 % at 12 months . Though moderate intensity PA increased in the EI and decreased in the MI , the difference between groups was not statistically significant ( p=0.45 ; multivariate model , p=0.08 ) ; however , moderate intensity PA assessed by question naire ( 92 % follow-up at 6 months and 75 % at 12 months ) was greater in the EI ( p=0.01 ; multivariate model , p=0.001 ) . For dietary outcomes , follow-up was 90 % for question naire and 92 % for serum carotenoids at 6 months and 74 % for question naire at 12 months . Dietary intake improved more in the EI compared to the MI ( question naire at 6 and 12 months , p<0.001 ; serum carotenoid index , p=0.05 ; multivariate model , p=0.03 ) . CONCLUSION The EI did not improve objective ly measured PA , but was associated with improved self-reported and objective measures of dietary intake BACKGROUND The Arizona Well-Integrated Screening and Evaluation for Women Across the Nation ( WISEWOMAN ) project used provider counseling , health education , and community health workers ( CHWs ) to target chronic disease risk factors in uninsured , primarily Hispanic women over age 50 . METHODS Participants were recruited from two Tucson clinics participating in the National Breast and Cervical Cancer Early Detection Program ( NBCCEDP ) . Women were r and omly assigned into one of three intervention groups : ( 1 ) provider counseling , ( 2 ) provider counseling and health education , or ( 3 ) provider counseling , health education , and CHW support . At baseline and 12 months ( 1998 - 2000 ) , participants were measured for height , weight , waist and hip circumference , and blood pressure . Blood tests were conducted to check blood glucose , cholesterol , and triglyceride levels . At each time point , participants also completed 24-hour dietary recalls and question naires focusing on their physical activity levels . RESULTS A total of 217 women participated in baseline and 12-month follow-up . Three fourths were Hispanic . All three intervention groups showed an increase in self-reported weekly minutes of moderate-to-vigorous physical activity , with no significant differences between the groups . Significantly more women who received the comprehensive intervention of provider counseling , health education , and CHW support progressed to eating five fruits and vegetables per day , compared with participants who received only provider counseling or provider counseling plus health education . CONCLUSIONS All three interventions increased moderate-to-vigorous physical activity but not fruit and vegetable consumption . The intervention group with provider counseling , health education , and CHW support significantly increased the number of women meeting national recommendations for fruit and vegetable consumption BACKGROUND Faith-based interventions hold promise for promoting health in ethnic minority population s. To date , however , few of these interventions have used a community-based participatory research ( CBPR ) approach , have targeted both physical activity and healthy eating , and have focused on structural changes in the church . PURPOSE To report the results of a group r and omized CBPR intervention targeting physical activity and healthy eating in African-American churches . DESIGN Group RCT . Data were collected from 2007 to 2011 . Statistical analyses were conducted in 2012 . SETTING / PARTICIPANTS Seventy-four African Method ist Episcopal ( AME ) churches in South Carolina and 1257 members within them participated in the study . INTERVENTION Churches were r and omized to an immediate ( intervention ) or delayed ( control ) 15-month intervention that targeted organizational and environmental changes consistent with the structural ecologic model . A CBPR approach guided intervention development . Intervention churches attended a full-day committee training and a full-day cook training . They also received a stipend and 15 months of mailings and technical assistance calls to support intervention implementation . MAIN OUTCOME MEASURES Primary outcomes were self-reported moderate- to vigorous-intensity physical activity ( MVPA ) , self-reported fruit and vegetable consumption , and measured blood pressure . Secondary outcomes were self-reported fat- and fiber-related behaviors . Measurements were taken at baseline and 15 months . Intent-to-treat repeated measures ANOVA tested group X time interactions , controlling for church clustering , wave , and size , and participant age , gender , and education . Post hoc ANCOVAs were conducted with measurement completers . RESULTS There was a significant effect favoring the intervention group in self-reported leisure-time MVPA ( d=0.18 , p=0.02 ) , but no effect for other outcomes . ANCOVA analyses showed an intervention effect for self-reported leisure-time MVPA ( d=0.17 , p=0.03 ) and self-reported fruit and vegetable consumption ( d=0.17 , p=0.03 ) . Trainings were evaluated very positively ( training evaluation item means of 4.2 - 4.8 on a 5-point scale ) . CONCLUSIONS This faith-based structural intervention using a CBPR framework showed small but significant increases in self-reported leisure-time MVPA . This program has potential for broad-based dissemination and reach . TRIAL REGISTRATION This study is registered at www . clinical trials.gov NCT00379925 OBJECTIVE This study examined whether 3-month outcomes of a brief image-based multiple behavior intervention on health habits and health-related quality of life of college students were sustained at 12-month follow-up without further intervention . METHODS A r and omized control trial was conducted with 303 undergraduates attending a public university in southeastern US . Participants were r and omized to receive either a brief intervention or usual care control , with baseline , 3-month , and 12-month data collected during fall of 2007 . RESULTS A significant omnibus MANOVA interaction effect was found for health-related quality of life , p=0.01 , with univariate interaction effects showing fewer days of poor spiritual health , social health , and restricted recent activity , p's<0.05 , for those receiving the brief intervention . Significant group by time interaction effects were found for driving after drinking , p=0.04 , and moderate exercise , p=0.04 , in favor of the brief intervention . Effect sizes typically increased over time and were small except for moderate size effects for social health-related quality of life . CONCLUSION This study found that 3-month outcomes from a brief image-based multiple behavior intervention for college students were partially sustained at 12-month follow-up
target: Preliminary evidence suggests that sequentially changing smoking alongside other risk behaviors was more effective than simultaneous change .
  Follow-up period and intervention characteristics impacted effectiveness for some outcomes .
  Interventions comprising education ( e.g. , providing information about behaviors associated with health risks ) and skills training ( e.g. , teaching skills that equip participants to engage in less risky behavior ) and targeting multiple risk behaviors concurrently are associated with small changes in diet and physical activity .
  Although on average smoking was reduced , it appeared changes in smoking were negatively associated with changes in other behaviors , suggesting it may not be optimal to target smoking simultaneously with other risk behaviors
background: CONTEXT Multiple risk behaviors are common and associated with developing chronic conditions such as heart disease , cancer , or Type 2 diabetes .