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Citation:

Thompson D, Baranowski T, Baranowski J, Cullen K, Jago R, Watson K, Liu Y.  Boy Scout 5-a-Day badge: outcome results of a troop and internet intervention.  Preventive Medicine 2009; 49:518-526.

Study Design:
Group randomized controlled trial
Class:
A - Click here for explanation of classification scheme.
POSITIVE: See Research Design and Implementation Criteria Checklist below.
Research Purpose:

Examine effects of a 5-A-Day intervention program on fruice juice and low-fat vegetable consumption.

Inclusion Criteria:

Troop inclusion criteria: High likelihood of home computer with Internet access.

Scout inclusion criteria: Participating troop membership, home computer with Internet access, written assent/consent.

Exclusion Criteria:

Troop exclusion criteria: Low likelihood of home computer with Internet access.

Scout exclusion criteria: No participating troop membership, no home computer with Internet access, lack of written consent/assent.

Description of Study Protocol:

Recruitment

Recruitment permission obtained from Houston Boy Scouts of America.  Presentations were made to troop leaders; Scouts were recruited from troops expressing interest.

Design

 Two-condition treatment, active-attention-placebo-control) group randomized trial with three data colelction periods (baseline, immediate post and 6-months post), conducted in two waves (Spring and Fall). 

Dietary Intake/Dietary Assessment Methodology (if applicable):

 Modified FFQ including 4 100% juices, 17 fruits and 17 vegetables.  Response scale represented the number of servings over previous 7 days.  Fruit & juice consumption was computed by summing servings of juice and fruit.  Low-fat vegetable consumption was computed by removing french fries, potato salad, and other potatoes from vegetables and computing servings of the other 14 lower fat items.

Blinding used (if applicable)

Partcipants, data collectors nor interventionists were blinded to the condition.

Intervention (if applicable)

The treatment group recieved an intervention to increased fruit and vegetable consumption.  The control group recieved an identically structured intervention to increase physical activity.  The treatment intervention included nine meeting components with content that varied each week.  The nine components were: 1) a meeting knowledge activity; 2) recipe preparation, 3) taste testing, 4) outcome expectancy, [INTERNET-based interventions]: 4) activity with skills presented in comic book, 5) problem solving poll, 6) goal setting, 7) goal review, 8) knowledge games, and 9) web activity. 

Statistical Analysis

Missing data were assessed at teh collection period level and each variable/scale level.  Primary outcome measures were analyzed using ProcMixed SAS procedure for group differences over the 3 time periods. 

 

Data Collection Summary:

Timing of Measurements

 Measurements were taken at baseline, immediate post-intervention and 6-months post-intervention.

Dependent Variables

  • Fruit and fruit juice consumption: Measured by FFQ. Consumption was presented as the non-averaged number of servings over the past 7 days.
  • Vegetable cosumption: Measured by FFQ. Consumption was presented as the non-averaged number of servings over the past 7 days.
  • Low-fat vegetable conumption: Measured by FFQ.  Determined by removing french fries, potato salad and other potatoes from vegetable responses.
  • Fruit and vegetable self-efficacy: Measued with a questionnaire ranging from "Disagree alot" to "Agree alot."
  • Fruit, juice and vegetable preferences: Measured with a questionnaire including "I do not like this" to "I like this alot."
  • Home fruit, juice and vegetable availability: Assessed on a yes/no response scale.

Independent Variables

Ethnicity, highest household educational attainment (by parental self-report), anthropometrics, intervention group, wave (Fall or Spring).

Control Variables

  • Social desirability: Assessed via 9-item "Lie Scale." 
  • Anthropometric and demographic varialbes were were included to examine moderating effects.
  • Changes in physical activity.
Description of Actual Data Sample:

Initial N: 736 were eligible

Attrition (final N): 473

Age: 10-14

Ethnicity: Participant characteristics reported in Jago et al. 2006

Other relevant demographics: male

Anthropometrics: Participant characteristics reported in Jago et al. 2006

Location: Houston, TX

 

Summary of Results:

 

Variables for Fruit and Juice

Treatment Group mean (SE)

Control group  mean (SE)

Difference in mean change

Consumption

Baseline

Post-1

Post-2

 

2.5 (0.1)

3.5 (0.1)

2.8 (0.1)

 

2.3 (0.1)

2.9 (0.1)

3.0 (0.1)

p=.003 baseline to post-1 Treatment: 0.94(0.0)

Control: 0.56 (0.0)

Availability

Baseline

Post-1

Post-2

 

9.0 (0.4)

10.9 (0.4)

10.0 (0.4)

 

9.1 (0.3)

9.7 (0.3)

10.0 (0.3)

 p=009 baseline to post-1 Treatment: 1.87(0.3)

Control: 0.58 (0.3)

Self-efficacy

Baseline

Post-1

Post-2

 

27.1 (0.5)

28.4 (0.5)

28.0 (0.5)

 

27.2 (0.4)

27.0 (0.4)

27.0 (0.5)

 p=0.68 baseline to post-1 Treatment: 0.68 (0.5)

Control: -0.77 (0.5)

Preferences

Baseline

Post-1

Post-2

 

 45.4 (0.7)

46.5 (0.6)

45.9 (0.7)

 

 45.3 (0.6)

45.3 (0.6)

44.4 (0.6)

No difference

Variables for low-fat vegetables

Treatment Group mean (SE)

Control group mean (SE)

Difference in mean change

Consumption

Baseline

Post-1

Post-2

 

2.0 (0.1)

2.5 (0.1)

2.1 (0.1)

 

1.6 (0.0)

1.9 (0.0)

2.2 (0.0)

p=014 baseline to Spring post-2

Treatment: -0.14 (0.1)

Control: 0.85 (0.1)

Availabiltiy

Baseline

Post-1

Post-2

 

8.2 (0.3)

9.4 (0.3)

8.9 (0.3)

 

8.2 (0.3)

8.7 (0.3)

9.0 (0.3)

 No difference

Self-efficacy

Baseline

Post-1

Post-2

 

22.8 (0.4)

24.6 (0.4)

24.0 (0.4)

 

22.6 (0.4)

22.5 (0.4)

23.1 (0.4)

p=.004 baseline to post-1

Treatment: 1.82 (0.4)

Control: 00.03 (0.4)

Preference

Baseline

Post-1

Post-2

 

32.5 (0.6)

33.4 (0.6)

33.1 (0.6)

 

31.3 (0.5)

32.0 (0.5)

31.9 (0.5)

No difference

 

Other Findings

The troop-associated intra-class correlations for all of the primary and secondary outcomes were between .00 and .04.  Neither household education nor psychosodial characteristics moderated the intervention effect.  Changes in fruit or vegetable intake did not significantly covary with change in physical activity.

Author Conclusion:

Results suggest a combined in-person and Internet-based program promoting fruit/fruit juice and low-fat vegetable consumption may be an effective method of enhancing short-term youth fruit/fruit juice consumption.  Additional reasearch is needed to identify methods to increase low-fat vegetabel intake to maintain changes over time.

Reviewer Comments:

Research Design and Implementation Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)
Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?
Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to nutrition or dietetics practice?
Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies)
Yes
 
Validity Questions
1. Was the research question clearly stated?
Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?
Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated?
Yes
  1.3. Were the target population and setting specified?
Yes
2. Was the selection of study subjects/patients free from bias?
Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?
Yes
  2.2. Were criteria applied equally to all study groups?
Yes
  2.3. Were health, demographics, and other characteristics of subjects described?
Yes
  2.4. Were the subjects/patients a representative sample of the relevant population?
Yes
3. Were study groups comparable?
Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)
Yes
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?
Yes
  3.3. Were concurrent controls used? (Concurrent preferred over historical controls.)
Yes
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?
N/A
  3.5. If case control or cross-sectional study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable. Criterion may not be applicable in some cross-sectional studies.)
N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?
N/A
4. Was method of handling withdrawals described?
Yes
  4.1. Were follow-up methods described and the same for all groups?
N/A
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)
Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for?
Yes
  4.4. Were reasons for withdrawals similar across groups?
Yes
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study?
N/A
5. Was blinding used to prevent introduction of bias?
No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?
No
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)
No
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?
N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status?
N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results?
N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?
Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied?
Yes
  6.2. In observational study, were interventions, study settings, and clinicians/provider described?
N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?
Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured?
Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described?
N/A
  6.6. Were extra or unplanned treatments described?
N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?
Yes
  6.8. In diagnostic study, were details of test administration and replication sufficient?
N/A
7. Were outcomes clearly defined and the measurements valid and reliable?
Yes
  7.1. Were primary and secondary endpoints described and relevant to the question?
Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern?
Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur?
???
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?
Yes
  7.5. Was the measurement of effect at an appropriate level of precision?
Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes?
Yes
  7.7. Were the measurements conducted consistently across groups?
Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators?
Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately?
Yes
  8.2. Were correct statistical tests used and assumptions of test not violated?
Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals?
Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?
N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?
Yes
  8.6. Was clinical significance as well as statistical significance reported?
N/A
  8.7. If negative findings, was a power calculation reported to address type 2 error?
Yes
9. Are conclusions supported by results with biases and limitations taken into consideration?
Yes
  9.1. Is there a discussion of findings?
Yes
  9.2. Are biases and study limitations identified and discussed?
Yes
10. Is bias due to study’s funding or sponsorship unlikely?
Yes
  10.1. Were sources of funding and investigators’ affiliations described?
Yes
  10.2. Was the study free from apparent conflict of interest?
Yes