Lack of effects of computer-tailored health education interventions

Computer-tailored health education that enables individualized, personal relevant information and feedback regarding healthful behavioral changes, has been regarded as a promising way to promote healthier life styles to contribute to better population health. Many studies, and systematic reviews of these studies, strongly indicate that computer-tailored health education is more effective than generic -one-size-fits-all health education. We have just conducted a new systematic review of computer-tailored interventions for promoting healthy diets and physical activity that will appear shortly in the journal Annals of Behavioral Medicine, and I will notify its publication here as zoos as it is out. However, I have been involved in a umber of studies recently that fail to show effects of computer-tailored interventions. There are a few reasons for lack of effects in these more recent studies, I believe. One reason is that these newer studies provide tailored feedback via web-based systems, while earlier studies used printed feedback letters or other printed materials as the means to provide participants with tailored feedback. In web-based interventions the actual exposure to the intervention content is often low and incomplete, because participants may be more easily distracted and may be less willing to read the information from the screen. Please see a recent review by Dr. Wendy Brouwer et al for an exploration of what may help to improve exposure to web-based interventions. Another reason for the lack of effects found in some recent studies is that in these more recent studies biomarkers or other objective measures of effects were used. In earlier research the assessment of effects were often based on self-reports, that may be biased for example because of social desirability bias. A recent study by Dr. Kroeze et al showed that effects of a computer-tailored nutrition education intervention aiming to help respondents to reduce their saturated fat intake levels based on self-reported fat intakes, could not be confirmed in further research using blood lipids as an objective indicator of effects.
This week a study by Karen Broekhuizen was pre-published in BMC Research Notes. In this study a computer-tailored loire style health education intervention was tested that aimed to help people with familiar hypercholesterolemia to adopt healthier lifestyles and to adhere to their statin treatment. This study used objective biomarkers to test this web-based computer-tailored intervention. The results indeed showed very low exposure to the web-based tailored feedback as well as lack of changes in lipids (low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and triglycerides), systolic blood pressure, glucose, body mass index (BMI) and waist circumference. Exposure to web-based tailored health education interventions obviously need to be improved in order to make present-day tailored e-health promotion interventions more effective.

The ENERGY project towards its final

The EuropeaN Energy balance Research to prevent excessive weight Gain among Youth (ENERGY) project uses the Intervention Mapping protocol to systematically use both existing scientific information and secondary analyses of evaluation data of existing schemes, as well as perform additional research to identify the most important intrinsic and extrinsic factors that determine energy-balance health behaviours, and translate this information into an evidence-based intervention scheme for 10-12 year old children in the transition age to adolescence. ENERGY is now in its final stages.  The entire project has used systematic reviews, secondary data analyses, a cross European cross-sectional school-based study and intervention study. The last few days we had our before-last ENERGY consortium meeting here in Amsterdam, where the consortium discussed the projects progress and made preparations for the ENERGY final symposium in Lyon on May 9, 9.00-12.00 AM, right before the upcoming European Congress on Obesity. At the final symposium we will present the results of the cross sectional and intervention studies. The results of the cross sectional study will soon be published in PLOS One, and I will report on that publication as soon as it is out. The results of the intervention study are now being analyzed and will be presented for the first time in Lyon.

Associations between Safety from Crime, Cycling, and Obesity in a Dutch Elderly Population: Results from the Longitudinal Aging Study Amsterdam

Cycling has been found to be a healthful daily physical activity, associated with lower risk for overweigh and obesity. People are more likley to cycle when they have the motivation, abilities and opportunities to use their bikes. In a paper we just published, with Dr. Stef Kremers as first author, in the Journal of Public and Environmental Health we explored the potential impact of safe opportunities for cycling on likelihood to cycle in a population of Dutch elderly. The objective of this cross-sectional study was to investigate differences in associations between crime rates, cycling, and weight status between people living in low and high socioeconomic status (SES) neighbourhoods. In total, 470 participants in the Longitudinal Aging Study Amsterdam were included (age: 63–70 y). Body height and weight were measured using a stadiometer and calibrated weight scale, respectively. Cycling behaviour was assessed in a face-to-face interview, and neighbourhood crime rates were assessed using data from police reports. Men from high SES neighbourhoods cycled more than men in low SES neighbourhoods and cycling was less negatively related to crime rates among both men and women in low SES neighbourhoods. This study indicates that neighbourhood safety issues should be considered in promoting cycling in lower SES neighbourhoods.

Lack of effectiveness of YouRAction, an Intervention to Promote Adolescent Physical Activity Using Personal and Environmental Feedback

YouRAction (targeting individual level determinants) and YouRAction+e (targeting in addition perceived environmental determinants) are two versions of a computer-tailored web-based interventions aiming to promote physical activity among adolescents. In a study just published in PLOS ONE with Rick Prins as first author, the one and six months effects of these computer-tailored interventions on compliance with the guideline to engage in at least one hour of moderate-to-vigorous physical activity (MVPA) per day are examined. Both tailored interventions were compared to web-based generich health education regarding physical activity.
Unfortunatley, there were no statistically significant intervention effects on compliance with the MVPA guideline, nor on overweight or waist circumference. Furthermore, the youngsters who were offered the YouRAction interventins were significantly less likely to have accessed the intervention on line compared to the generic health education.
This study could thus not demonstrate that the YouRAction and YouRAction+e interventions were effective and insufficient use and exposure to the intervention content may be an explanation for the lack of effects. These results differ from the larger evidence-base regarding computer-tailored health education. recent reviews of the literature suggest that computer-tailored health education is in general more effective than generic information.

The SPOTLIGHT project kick off meeting

Today the official start of the Sustainable Prevention of Obesity Through Integrated Strategies (SPOTLIGHT) project officially started with a meeting at the VU University medical center's EMGO+ institute. SPOTLIGHT is a cross European research project funded within the European Commission's 7th Framework program.
The SPOTLIGHT project aims to contribute to fighting the obesity epidemic. The prevalence of overweight and obesity in Europe is high and contribute to mortality and the burden of many chronic diseases, especially within groups of lower social-economic status. Obesity is largely determined by modifiable lifestyle dependent risk factors such as reduced physical activity, sedentary behaviour and an unhealthy diet. There is growing evidence that influences on individuals and their lifestyle should not only be addressed in single-level interventions that focus on a distinct individual, social or environmental aspect, but rather in community based multi-level intervention approaches (MIAs) that integrate individual, community, organisational, and societal systems.
SPOTLIGHT aims to increase and combine knowledge on the wide  ange of determinants of obesity in a systematic way, and to identify MIAs that are strong in terms of Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM). A further aim is to identify factors for successful implementation of MIAs into health promotion practice.
By combining published research and collected cross-European data with expert and target-group perspectives, effective, sustainable and implementable MIAs that counteract obesogenic behaviours in adults will be defined. We will provide an evidence-based model for effective MIAs in health promotion practice applicable across Europe, and disseminate our findings by policy makers and the scientific community. We will develop a handbook with evidence- and practice-based instructions as well as practical recommendations for policies and interventions, suggestions and reference to best practice that serve as a major dissemination tool.

A roadmap to an obesity research agenda for Europe

With the Horizon 2020 program of the European Commission in its final stages of development, it is of crucial importance to showcase the most important health issues to the European decision makers and influencers. See http://ec.europa.eu/research/horizon2020/index_en.cfm for more information regarding Horizon 2020. Obesity is certainly one of them. Obesity is one of the most important determinants of avoidable burden of disease.
Today a meeting organised by the European Association of the Study of Obesity was held in Brussels to communicate and help define the research agenda for the Horizon 2020 era regarding obesity prevention and treatment. A trans disciplinary team of researchers from across Europe with their specialities in for example, animal models, medical treatment of obesity, behavioral sciences, public health et cetera presented and discussed what they believe to be the main priorities for further obesity research in the years to come.

The ENERGY project; a writing retreat and gourmet Nordic food

Last week we had a 3-day meeting at Agder University in Kristiansand, Norway, to analyse and prepare scientific reports of the results of the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth” (ENERGY)-project. ENERGY is the development and formative evaluation of a theory-informed and evidence-based multi-component school-based and family-involved intervention program ready to be implemented and evaluated for effectiveness across Europe. This project consisting of a conceptual framework, systematic reviews and secondary data analyses, validation studies, as well as a cross sectional study and an intervention study across different countries in Europe, finalizes this summer. The reporting on the firts pases of the project is well underway, and we are now in the process of analysing the evaluation of the intervention, called UP4FUN.

Our project is aiming to promote health diets and physical activity among school-age children. Most of the researchers in the ENERGY project  try to practice what they preach. In recent years there is a big emphasis in healthy diet promotion on regional, health promoting foods and diets. Such regionally appropriate, gourmet, good-for-health-and environment diets get a strong emphasis in the Nordic countries, and has been labelled the Nordic Diet. The best restaurant of the world -NOMA restaurant in Copenhagen-, as well as other Michelin star restaurants in the Nordic countries, such as Frantzen/Lindeberg in Stockholm, are strong advocates of the Nordic kitchen and have taken the Nordic cooking to top levels. Prof. Elling Bere, one of our hosts at Agder University, and me have published one of the first scientific papers proposing a Nordic diet, and comparing the Nordic diet with maybe the most famous regionally defined healthful diet, i.e. the Mediterranean diet.

Kristiansand has its own proud example of a Gourmet Nordic restaurant, i.e. Maltid restaurant. One of the evening dinners we had at the home of Froydis Nordgard Vik, one of the PhD candidates and crucial collaborators on the ENERGY project, and she had arranged for food delivered by and prepared at her home by Maltid so that were provided the opportunity to practice Nordic health-promoting eating in the best possible way.