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Individual Changes from Intervention: How Much Can We Expect?

Individual Changes from Intervention: How Much Can We Expect?. Tom Baranowski, Ph.D. Professor of Pediatrics (Behavioral Nutrition) USDA/ARS - Children’s Nutrition Research Center Baylor College of Medicine Houston, TX. Save the Best for Last?. OR.

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Individual Changes from Intervention: How Much Can We Expect?

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  1. Individual Changes from Intervention: How Much Can We Expect? Tom Baranowski, Ph.D. Professor of Pediatrics (Behavioral Nutrition) USDA/ARS - Children’s Nutrition Research Center Baylor College of Medicine Houston, TX

  2. Save the Best for Last? OR Antagonize the Fewest People Since Most People Have Already Left?

  3. Effect Sizes Objectives: • Review school based interventions • Provide critique of literature

  4. Inclusionary Criteria To enhance confidence in estimates: • School as unit • Adequate power To assess interesting possibilities: • Environment vs. curriculum • Innovation

  5. Elementary Schools: CATCH Eat Well & Keep Moving High 5 Alabama Pathways Bienestar Cafeteria Power Plus Middle Schools: Planet Health MSPAN FV Make the Marks Studies Included

  6. Effect Sizes - Body Composition/Obesity

  7. Effect Sizes - Body Composition/Obesity

  8. Effect Sizes - Body Composition/Obesity

  9. Effect Sizes - Body Composition/Obesity

  10. Effect Sizes - Total Energy Intake

  11. Effect Sizes - Total Energy Intake

  12. Effect Sizes - Total Energy Intake

  13. Effect Sizes - Total Energy Intake

  14. Effect Sizes - F&V Servings per Day

  15. Effect Sizes - F&V Servings per Day

  16. Effect Sizes - F&V Servings per Day

  17. Effect Sizes - F&V Servings per Day

  18. Effect Sizes - F&V Servings per Day

  19. Effect Sizes - MVPA

  20. Effect Sizes - MVPA

  21. Effect Sizes - MVPA

  22. Effect Sizes - Sedentary Behaviors

  23. Effect Sizes - Sedentary Behaviors

  24. Overview of Effect Sizes • Changes in adiposity and related behaviors have been found • But not always • Sometimes moderated effects • Changes tend to be small in absolute amounts • But one economic analysis suggests even small changes can be cost effective

  25. Overview of Effect Sizes • Desired changes tend to occur in treatment & control groups • Minimizing differences • Not sure want decreases in kcal • But qualitative changes (more likely to get)

  26. Overview of Effect Sizes • Reported in original units, not in SD units • Error will vary across studies • Reflected in SD • Compensation of effects outside of school?

  27. Hard to Compare • Different interventions • Different measures • Different methods • Controlled for different variables • Reported results in different ways • Logically inconsistent across variables within studies • Inconsistent findings across studies

  28. Mediating Variable Model (Conceptual) Intervention Design Moderating Variables Implementation Mediating Variables Outcomes Rewards?

  29. Mediating Variable Model (2) (see Baranowski, et al, 2003 Obesity Research)

  30. Mediating Variable Model (3) A model for program planning and outcome analysis

  31. B A R R I E R S -Type -Diff Content -Types -Levels N1 Exposure Initial Use Continued Use -Preference -Type -Type -Extent -Amount -Amount Design & Development of Intervention Implementation -Fidelity -Extent N2 Exposure Initial Use Continued Use -Preference -Type -Type -Extent -Amount -Amount  Resources -Types -Levels Nk Exposure Initial Use Continued Use -Preference -Type -Type -Extent -Amount -Amount Reach -Depth -Spread (Baranowski T, Stables G. Process Evaluation of the 5-A-Day Projects. Health Education &Behavior 2000, 27:157-166.) Process Evaluation as Mediators

  32. Intervention  Implementation • What are the 5 major contributors to obesity in each age group? • Provide foci for intervention • How much change is needed to move physiological variables? • Need more controlled research, diet & PA • How much change get when move physical variables?

  33. Intervention  Implementation • Need for innovation • Basic research on manipulating moderators • New procedures • Cameras with statements • Low cost / non curricular • Interactive multimedia games

  34. Intervention  Implementation • Need innovation (continued) • New theories • Self concept/cognitive dissonance • Theory of planned behavior (EU) • Family influences • Food shopping? • New locations • Summer day camp • Gender & age difference in design - especially PA

  35. Implementation  Psychosocial Change • Need to monitor implementation (50%, 22%) • Need to find ways around classroom teachers • New PS measures - IRT?

  36. Psychosocial Change  Behavior Change • Need more basic correlates research • Not enough range in normal PS or behavior to detect relationships? • Random (chaos theory) or determinate? • Need mediating variables analyses • Need moderating variable analyses • Gender • SES • Local environment

  37. Behavior Change  Psychosocial Change  Adiposity Change • Does BMI discourage PA? When? • PROP sensitivity predispose to obesity? • Role of the hormones (leptin, ghrelin) in obesity prevention? • Mediating vs. moderating effects?

  38. Need a National Discussion • Role of schools? • Role of families? • Role of government? • Role of child agencies? • Boy Scouts, YMCA

  39. Thank You for Listening! Merci Beaucoup! Muchas Gratias! Epharisto! Tack Så Mycket! Dzienkuje Bardzo!

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