Effects of a behavioral and health literacy intervention to reduce sugar-sweetened beverages: a randomized-controlled trial. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Zoellner, Jamie; Hedrick, Valisa; You, Wen; Chen, Yvonnes; Davy, Brenda; Porter, Kathleen; Bailey, Angela; Lane, Hannah; Alexander, Ramine; Estabrooks, Paul
• Is Part Of: International journal of behavioral nutrition and physical activity. Volume 13:Issue 1(2016)
• Page Start: 1
• Page End: 12
• Publication Date: 2016-12
• Subjects: Beverages -- Health literacy -- Behavioral research -- Randomized controlled trial -- Rural population; Diet -- Periodicals; Physical fitness -- Periodicals; 613.2
• DOI: 10.1186/s12966-016-0362-1
• Languages: English
• ISSNs: 1479-5868

Abstract

Abstract Background Despite excessive consumption of sugar-sweetened beverages (SSB), little is known about behavioral interventions to reduce SSB intake among adults, particularly in medically-underserved rural communities. This type 1 effectiveness-implementation hybrid RCT, conducted in 2012–2014, applied the RE-AIM framework and was designed to assess the effectiveness of a behavioral intervention targeting SSB consumption (SIPsmart ER) when compared to an intervention targeting physical activity (MoveMore) and to determine if health literacy influenced retention, engagement or outcomes. Methods Guided by the Theory of Planned Behavior and health literacy strategies, the 6 month multi-component intervention for both conditions included three small-group classes, one live teach-back call, and 11 interactive voice response calls. Validated measures were used to assess SSB consumption (primary outcome) and all secondary outcomes including physical activity behaviors, theory-based constructs, quality of life, media literacy, anthropometric, and biological outcomes. Results Targeting a medically-underserved rural region in southwest Virginia, 1056 adult participants were screened, 620 (59 %) eligible, 301 (49 %) enrolled and randomized, and 296 included in these 2015 analyses. Participants were 93 % Caucasian, 81 % female, 31 % ≤ high-school educated, 43 % < $14, 999 household income, and 33 % low health literate. Retention rates (74 %) and program engagement was not statistically different between conditions. Compared to MoveMore, SIPsmart ER participants significantly decreased SSB kcals and BMI at 6 months. SIPsmart ER participants significantly decreased SSB intake by 227 (95 % CI = −326, −127, p < 0.001) kcals/day from baseline to 6 months when compared to the decrease of 53 (95 % CI = −88, −17, p < 0.01) kcals/day among MoveMore participants (p < 0.001). SIPsmart ER participants decreased BMI by 0.21 (95 % CI = −0.35, −0.06;p < 0.01) kg/m2 from baseline to 6 months when compared to the non-significant 0.10 (95 % CI = −0.23, 0.43; NS) kg/m2 gain among MoveMore participants (p < 0.05). Significant 0–6 month effects were observed for about half of the theory-based constructs, but for no biological outcomes. Health literacy status did not influence retention rates, engagement or outcomes. Conclusions SIPsmart ER is an effective intervention to decrease SSB consumption among adults and is promising for translation into practice settings. SIPsmart ER also yielded small, yet significant, improvements in BMI. By using health literacy-focused strategies, the intervention was robust in achieving reductions for participants of varying health literacy status. Trial registration Clinicaltrials.gov; ID:NCT02193009 .