SIPsmartER: A nutrition literacy approach to reducing sugar-sweetened beverages

描述（由申请人提供）：尽管含糖饮料（SSB）对总能量摄入有重大影响，而且在过去25年里，美国的含糖饮料消费量翻了一番；目前还没有明确针对成年人减少SSB摄入量的疗效试验。此外，健康素养较低的成年人消耗的SSB量较高，该领域缺乏基于理论的干预措施来支持这一人群的行为改变。本研究明确针对通过改善健康素养来改变SSB摄入量的目标，健康素养在营养背景下被定义为营养计算能力（阅读、理解和应用数字以做出适当饮食决定的能力）和营养相关媒体素养（获取、分析和评估营养相关媒体的能力）。项目第一阶段利用焦点小组和试点测试方法来指导干预措施的制定。第二阶段的主要目标是进行一项三组随机对照试验，以确定与匹配接触对照条件相比，基于计划行为理论（TPB）的SSB干预（含（SIPmatE）和不含（SIPmart）增强和综合营养素养成分，针对营养计算能力和营养相关媒体素养）的相对有效性。所有三个为期6个月的干预都将使用面对面、小组沟通渠道和通过交互式语音应答（IVR）技术进行自动自我监控。目标人群包括639名低社会经济水平的参与者，他们居住在弗吉尼亚州西南部11个有风险的农村县。所有结果将在基线、干预后6个月和12个月（即基线后18个月）进行评估。主要指标是SSB摄入量，次要指标包括体重和添加糖摄入量的新型无创13C生物标志物技术。主要和次要结局的变化将使用混合效应模型来确定，以解释多重治疗框架内的个体、时间和群体差异。RE-AIM框架的组成部分（即覆盖范围、有效性、采用、实施和维护）也将被评估和评估，以及每个部门的成本效益模型。本研究通过将动机/意向过程与基于技能的营养素养过程结合起来，以了解现实世界和自然发生的社区环境下影响生活方式行为的因果途径和复杂关系，填补了健康素养文献中的一个重要空白。本研究的长期目标是提高健康差异人群的营养素养，减少SSB消费和与过量热量和添加糖消费相关的相关不良健康后果（即肥胖，II型糖尿病，冠心病，龋齿和癌症），弥合健康行为理论和健康素养概念之间的概念差距。在难以接触到的人群中扩大简单和具有成本效益的干预措施的覆盖范围，并减少对自我报告饮食摄入措施的依赖。

DESCRIPTION (provided by applicant): Despite the substantial impact sugar-sweetened beverages (SSB) have on total energy intake and the fact that consumption has doubled in the US over the past 25 years; there are no known efficacy trials that have specifically targeted reducing SSB intake among adults. Furthermore, adults with lower health literacy consume higher amounts of SSB and the field lacks theory-based interventions to support behavior change in this population. This research explicitly targets changes in SSB intake through improvements in health literacy, defined within a nutrition context as nutrition numeracy (the ability to read, understand, and apply numbers to make appropriate dietary decisions) and nutrition-related media literacy (the ability to access, analyze, and evaluate nutrition-related media). Phase 1 of the project utilizes focus groups and pilot testing methodologies to guide development of the interventions. The primary objective for Phase 2 is to conduct a three group randomized controlled trial to determine the relative effectiveness of a Theory of Planned Behavior (TPB)-based SSB intervention with (SIPmatE) and without (SIPmart) an enhanced and integrated nutrition literacy component targeting nutrition numeracy and nutrition-related media literacy, as compared to a matched-contact control condition. All three 6-month interventions will be delivered using in- person, small-group communication channels and automated self-monitoring through interactive voice response (IVR) technology. The target population includes 639 low socioeconomic participants residing in 11 at-risk, rural southwest Virginia counties. All outcomes will be assessed at baseline, 6 months, and 12 months post intervention (i.e., 18 months post baseline). The primary outcome is SSB consumption, and secondary outcomes include body weight and a new non-invasive 13C biomarker technique for added sugar intake. Changes in the primary and secondary outcomes will be determined using a mixed effect model to account for individual, time, and group differences within a multitreatment framework. Components from the RE-AIM framework (i.e. reach, effectiveness, adoption, implementation, & maintenance) will also be assessed and evaluated, along with cost-effectiveness models for each arm. This study fills an important void in the health literacy literature by integrating motivation/intention processes with skill-based nutrition literacy processes to understand causal pathways and complex relationships impacting a life-style behavior under real world and naturally occurring community environments. The long-term goals of this research are to improve nutrition literacy among health disparate populations, reduce SSB consumption and the associated adverse health consequences related to excessive caloric and added sugar consumption (i.e. obesity, type II diabetes, coronary heart disease, dental caries, and cancer), bridge the conceptual gap among concepts in health behavior theory and health literacy, expand the reach of simple and cost-effective interventions among hard-to- reach populations, and reduce the reliance on self-reported measures of dietary intake.