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 (SIPsmartER) 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, SIPsmartER participants significantly decreased SSB kcals and BMI at 6 months. SIPsmartER 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). SIPsmartER participants decreased BMI by 0.21 (95 % CI = −0.35,−0.06; p < 0.01) kg/m

Purpose To test the feasibility of Kids SIPsmartER, a school-based intervention to reduce consumption of sugar-sweetened beverages (SSBs). Design Matched-contact randomized crossover study with mixed-methods analysis. Setting One middle school in rural, Appalachian Virginia. Participants Seventy-four sixth and seventh graders (5 classrooms) received Kids SIPsmartER in random order over 2 intervention periods. Feasibility outcomes were assessed among 2 teachers. Intervention Kids SIPsmartER consisted of 6 lessons grounded in the Theory of Planned Behavior, media literacy, and public health literacy and aimed to improve individual SSB behaviors and understanding of media literacy and prevalent regional disparities. The matched-contact intervention promoted physical activity. Measures Beverage Intake Questionnaire-15 (SSB consumption), validated theory questionnaires, feasibility questionnaires (student and teacher), student focus groups, teacher interviews, and process data (eg, attendance). Analysis Repeated measures analysis of variances across 3 time points, descriptive statistics, and deductive analysis of qualitative data. Results During the first intervention period, students receiving Kids SIPsmartER (n = 43) significantly reduced SSBs by 11 ounces/day (P = .01) and improved media (P < .001) and public health literacy (P < .01) understanding; however, only media literacy showed between-group differences (P < .01). Students and teachers found Kids SIPsmartER acceptable, in-demand, practical, and implementable within existing resources. Conclusion Kids SIPsmartER is feasible in an underresourced, rural school setting. Results will inform further development and large-scale testing of Kids SIPsmartER to reduce SSBs among rural adolescents.

Background: The reduction of sugar-sweetened beverage (SSB) intake may be beneficial for weight management and other related health conditions; however, to our knowledge, no data exist regarding the spontaneous changes in other dietary components or the overall dietary quality after an SSB-reduction intervention. Objectives: We explored longitudinal changes within and between an SSB-reduction intervention (SIPsmartER) and a physical activity intervention (MoveMore) with respect to spontaneous changes in 1) energy intake and macronutrients and micronutrients, 2) dietary quality [Healthy Eating Index-2010 (HEI)], and 3) beverage categories. Design: Participants were enrolled in a 6-mo, community-based behavioral trial and randomly assigned into either the SIPsmartER (n = 149) intervention group or the MoveMore (n = 143) matched-contact comparison group. Dietary intake was assessed through a mean of three 24-h dietary recalls at baseline and 6 mo. Dietary recalls were analyzed with the use of nutritional analysis software. A multilevel, mixed-effects linear regression with intention-to-treat analyses is presented. Results: SIPsmartER participants showed a significant reduction in total SSBs (mean decrease: 2366 mL; P # 0.001). Several spontaneous changes occurred within the SIPsmartER group and, compared with the MoveMore group, included significant HEI improvements for empty calorie, total vegetable, and total HEI scores (mean increases: 2.6, 0.3, and 2.6, respectively; all P # 0.01). Additional positive changes were shown, including significant decreases in total energy intake, trans fat, added sugars, and total beverage energy (all P # 0.05). Few dietary changes were noted in the MoveMore group over the 6-mo intervention.

Background Sugar-sweetened beverage (SSB) consumption among children and adolescents is a determinant of childhood obesity. Many programs to reduce consumption across the socio-ecological model report significant positive results; however, the generalizability of the results, including whether reporting differences exist among socio-ecological strategy levels, is unknown. Objectives This systematic review aims to (1) examine the extent to which studies reported internal and external validity indicators defined by RE-AIM (reach, effectiveness, adoption, implementation, maintenance) and (2) assess reporting differences by socio-ecological level: intrapersonal/interpersonal (Level 1), environmental/policy (Level 2), multi-level (Combined Level). Methods Six major databases (PubMed, Web of Science, Cinahl, CAB Abstracts, ERIC, and Agiricola) systematic literature review was conducted to identify studies from 2004–2015 meeting inclusion criteria (targeting children aged 3–12, adolescents 13–17, and young adults 18 years, experimental/quasi-experimental, substantial SSB component). Interventions were categorized by socio-ecological level, and data were extracted using a validated RE-AIM protocol. A one-way ANOVA assessed differences between levels. Results There were 55 eligible studies (N) accepted, including 21 Level 1, 18 Level 2, and 16 Combined Level studies. Thirty-six (65%) were conducted in the USA, 19 (35%) internationally, and 39 (71%) were implemented in schools. Across levels, reporting averages were low for all RE-AIM dimensions (reach=29%, efficacy/effectiveness=45%, adoption=26%, implementation=27%, maintenance=14%). Level 2 studies had significantly lower reporting on reach and effectiveness (10% and 26%, respectively) compared to Level 1 (44%, 57%) or Combined Level studies (31%, 52%) (p<0.001). Adoption, implementation, and maintenance reporting did not vary among levels. Conclusion Interventions to reduce SSB in children and adolescents across the socio-ecological spectrum do not provide the necessary information for dissemination and implementation in community nutrition settings. Future interventions should address both internal and external validity to maximize population impact.

Objective To compare self-reported and measured energy intake in weight-restored patients with anorexia nervosa (AN), weight-stable obese individuals (OB), and normal weight controls (NC). Method Forty participants (18 AN, 10 OB, and 12 NC) in a laboratory meal study simultaneously completed a prospective food record. Results AN patients significantly (p = .018) over-reported energy intake (16%, 50 kcal) and Bland-Altman (B-A) analysis indicated bias toward over-reporting at increasing levels of intake. OB participants significantly (p = .016) under-reported intake (19%, 160 kcal) and B-A analysis indicated bias toward under-reporting at increasing levels of intake. In NC participants, NS (p = .752) difference between reported and measured intake was found and B-A analysis indicated good agreement between methods at all intake levels. Discussion Self-reported intake should be cautiously interpreted in AN and OB. Future studies are warranted to determine if over-reporting is related to poor outcome and relapse in AN, or under-reporting interferes with weight loss efforts in OB.