We identified characteristics of effective interventions. These findings may inform the development of future interventions targeting dietary behavior in preadolescents and adolescents in the school-based setting.

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Objective. Effective interventions are needed to address the reported inadequacies of dairy product and calcium (Ca) intakes among adolescents. The present review investigated interventions aimed at increasing adolescent dairy and/or Ca intakes and determined the characteristics associated with successful interventions. Design. A PRISMA systematic review search identified 17 interventions, described in 16 publications, between 1993 and 2015 (February). Studies were evaluated for population, delivery, dietary targets and outcomes measures, measure of intervention intensity, use of behavior change techniques, intervention effectiveness, and effect size and quality. Setting. Interventions targeting an increase in dairy food or Ca intake, either exclusively or in combination with other dietary modifications. Subjects. Adolescents, aged 12 to 18 years. Results. Twelve of the 17 interventions were found to be effective. Effective interventions tended to be higher in overall intensity (mean intensity: negative interventions 12.2, positive interventions 14.25), with the most notable difference in the duration category, such that effective interventions tended to be longer in duration. The number of behavior change techniques applied did not differentiate effective and ineffective interventions, but prompting the review of behavioral goals and including interviews or brief counseling appeared to be important for effective interventions. Effective interventions tended to have higher methodological quality, while the majority of ineffective interventions were qualitatively assessed as weak. Conclusions. The current review has identified characteristics of effective interventions that offer insight into promising strategies likely to increase dairy consumption and Ca intakes in countries where adolescent intake is insufficient. These findings may have important implications for future intervention design.

BackgroundLyme disease (LD) is a complex tick-borne pathology caused by Borrelia burgdorferi sensu lato bacteria. Currently, there are limited data regarding the health outcomes of people infected during pregnancy, the potential for perinatal transmission to their fetus, and the long-term effects on these children. Therefore, the primary objective of this survey study was to investigate the impact of LD in pregnancy on both the parent and their offspring.MethodsA seven-section survey was developed and administered in REDCap. Although recruitment was primarily through LD-focused organizations, participation was open to anyone over the age of 18 who had been pregnant. Participant health/symptoms were compared across those with “Diagnosed LD,” “Suspected LD,” or “No LD” at any time in their lives. The timing of LD events in the participants’ histories (tick bite, diagnosis, treatment start, etc.) were then utilized to classify the participants’ pregnancies into one of five groups: “Probable Treated LD,” “Probable Untreated LD,” “Possible Untreated LD,” “No Evidence of LD,” and “Unclear.”ResultsA total of 691 eligible people participated in the survey, of whom 65% had Diagnosed LD, 6% had Suspected LD, and 29% had No LD ever. Both the Diagnosed LD and Suspected LD groups indicated a high symptom burden (p < 0.01). Unfortunately, direct testing of fetal/newborn tissues for Borrelia burgdorferi only occurred following 3% of pregnancies at risk of transmission; positive/equivocal results were obtained in 14% of these cases. Pregnancies with No Evidence of LD experienced the fewest complications (p < 0.01) and were most likely to result in a live birth (p = 0.01) and limited short- and long-term offspring pathologies (p < 0.01). Within the LD-affected pregnancy groups, obtaining treatment did not decrease complications for the parent themselves but did ameliorate neonatal health status, with reduced rates of rashes, hypotonia, and respiratory distress (all p < 0.01). The impact of parent LD treatment on longer-term child outcomes was less clear.ConclusionOverall, this pioneering survey represents significant progress toward understanding the effects of LD on pregnancy and child health. A large prospective study of pregnant people with LD, combining consistent diagnostic testing, exhaustive assessment of fetal/newborn samples, and long-term offspring follow-up, is warranted.