Background The rapid increase of obesity and diabetes risk beginning in youth, particularly those from disadvantaged communities, calls for prevention efforts. Objective To examine the impact of a curriculum intervention, Choice, Control, and Change (C3), on the adoption of the energy balance related behaviors of decreasing sweetened drinks, packaged snacks, fast food, and leisure screen time, and increasing water, fruits and vegetables, and physical activity, and on potential psychosocial mediators of the behaviors. Design Ten middle schools in low-income New York City neighborhoods were randomly assigned within matched pairs to either intervention or comparison/ delayed control conditions during the 2007–2008 school year. Participants 562 inner city seventh grade students in the intervention condition, and 574 in the comparison condition. Intervention Students received the 24 C3 lessons that used science inquiry-based investigations to enhance motivation for action, and social cognitive and self-determination theories to increase personal agency and autonomous motivation to take action. Main outcome measures Self-report instruments to measure energy balance related behaviors targeted by the curriculum, and potential psychosocial mediators of the behaviors. Analyses ANCOVA with group (intervention/control) as a fixed factor and pre-test as covariate. Results Students in intervention schools compared to the delayed intervention controls reported consumption of significantly fewer sweetened drinks and packaged snacks, smaller sizes of fast food, increased intentional walking for exercise, and decreased leisure screen-time, but showed no increases in their intakes of water, fruits, and vegetables. They showed significant increases in positive outcome expectations about the behaviors, self-efficacy, goal intentions, competence, and autonomy. Conclusions The C3 curriculum was effective in improving many of the specifically targeted behaviors related to reducing obesity risk, indicating that combining inquiry-based science education and behavioral theory is a promising approach.

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Purpose-To examine the efficacy of an intervention based on the transtheoretical model (TTM) for increasing fruit and vegetable consumption among economically disadvantaged AfricanAmerican adolescents. Design-Pretest-posttest quasi-experimental study.Setting-Youth services agencies located in New York, New Jersey, and Pennsylvania. Agencies were assigned to computer intervention (CIN) and nonintervention control study arms.Subjects-A total of 507 African-American adolescents ages 11 to 14 years.Intervention-Youths in the CIN arm completed four 30-minute intervention sessions tailored on TTM stages and processes of change.Measures-Self-reported fruit and vegetable consumption and stages, pros, cons, and self-efficacy for consumption.Analysis-Intervention effects were examined with analysis of covariance models that were controlled for demographic variables and baseline measures of each outcome. Chi-square analyses were used to examine between-arm differences in youths' stage progressions.Results-After adjustment by covariates, pros (p < .025) and fruit and vegetable consumption (p < .001) varied significantly with study arm. Youths in the CIN arm had higher pro scores and fruit and vegetable consumption than controls. More youths in the CIN arm than in the control arm progressed to later stages and maintained recommended intake levels (p < .05).Conclusions-A TTM-based intervention can increase fruit and vegetable intake and effect positive changes in TTM variables related to intake among economically disadvantaged AfricanAmerican adolescents.Send reprint requests to Jennifer Di Noia, PhD, Columbia University School of Social Work, 1255 Amsterdam Ave., New York, NY 10027; jd201@columbia.edu. NIH Public Access PURPOSESubstantial epidemiologic evidence supports the protective role of fruits and vegetables in the prevention of cancer. 1 Despite the health benefits of a diet rich in fruits and vegetables, fewer than one fourth of African-American adolescents consume the minimum five recommended daily servings and, like U.S. adolescents from other racial/ethnic groups, their average intake decreases with income. 2 Although African-Americans comprise a modest 13% of the U.S. population, cancer incidence and mortality rates are higher among African-Americans than they are among members of any other U.S. racial and ethnic group. 3,4 Their low fruit and vegetable intake and high cancer incidence suggest that economically disadvantaged AfricanAmerican adolescents would benefit from intervention to increase fruit and vegetable consumption.The transtheoretical model (TTM) provides a theoretical framework for developing interventions to modify a variety of health behaviors. 5 The model comprises four constructs: (1) stages of change, the temporal readiness to modify health behavior; (2) decisional balance, the relative importance of the perceived pros and cons of change; (3) situational selfefficacy, confidence in one's ability to modify the behavior across positive social, negative affect, and difficult situations; a...