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）对总能量摄入量有重大影响，而且在过去25年中，美国的消费量翻了一番;但尚无专门针对减少成人SSB摄入量的已知疗效试验。此外，健康素养较低的成年人消费更多的SSB，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。这项研究明确针对通过改善健康素养来改变SSB摄入量，在营养背景下定义为营养计算能力（阅读，理解和应用数字做出适当饮食决定的能力）和营养相关媒体素养（访问，分析和评估营养相关媒体的能力）。该项目的第一阶段利用重点小组和试点测试方法来指导干预措施的制定。第2阶段的主要目标是进行一项三组随机对照试验，以确定与匹配的接触对照条件相比，基于计划行为理论（TPB）的SSB干预（SIPmatE）和（SIPmartE）的相对有效性，增强和综合营养素养组件针对营养算术和营养相关媒体素养。所有三个为期6个月的干预措施都将通过面对面、小组沟通渠道和交互式语音应答（IVR）技术进行自动自我监测。目标人群包括居住在弗吉尼亚州西南部11个有风险的农村县的639名低社会经济参与者。将在基线、干预后6个月和12个月（即，基线后18个月）。主要结果是SSB消耗量，次要结果包括体重和一种新的非侵入性13 C生物标志物技术，用于补充糖摄入量。将使用混合效应模型确定主要和次要结局的变化，以解释多治疗框架内的个体、时间和组差异。RE-AIM框架的组件（即覆盖范围、有效性、采用、实施和维护）也将进行评估和评价，沿着每个臂的成本效益模型。这项研究填补了健康素养文献中的一个重要空白，将动机/意图过程与基于技能的营养素养过程相结合，以了解影响生活的因果途径和复杂关系。风格行为在真实的世界和自然发生的社区环境。这项研究的长期目标是提高健康不同人群的营养素养，减少SSB消费以及与过量热量和添加糖消费相关的不良健康后果（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鸿沟，在难以接触到的人群中扩大简单且具有成本效益的干预措施的覆盖范围，并减少对自我报告的饮食摄入量测量的依赖。

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 multi-treatment 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.