Cost Effectiveness of Interventions for Teen Diet and Exercise
- Presenter:
Chair: Michael Hagan; Discussant: Michael Hagan Wed June 7, 2006 9:45-11:15 Room 121
PURPOSE: To test the effectiveness of a school-based intervention on dietary fat intake and physical activity, determine which intervention was more effective in reducing dietary fat and increasing physical activity in middle school youth, and to assess the cost of each intervention in relation to effectiveness.
BACKGROUND: Obesity in children results in many health problems during childhood and later in life. Healthy People 2010 goals include reducing overweight among adolescents aged 12-19 through sound dietary practices and increased physical activity. African Americans, Hispanics, Native Americans and children from low-income families in any race are most at risk for obesity and associated health problems. Project FUN was developed using the Health Promotion/Transtheoretical Model to tailor computerized interventions. Tailored interventions, used in the computerized model, modify feedback based on characteristics previously demonstrated to improve nutrition and exercise behaviors. Individualized interventions, used in the Email model, modify feedback based on many characteristics evident in clients. The third model utilized peers to provide group support for healthy behaviors.
METHODS: Culturally diverse, low-middle income, 6th and 7th grade youth (N=447) were assigned by classroom to the control or one of the three intervention groups to avoid diffusion of the interventions to the control condition. The first intervention group received education from a computerized model, the second group had the computerized model plus Emailed feedback, and the third group had the computerized model plus access to peer feedback. Trained nursing students gave individual Emailed responses to students’ answers to questions posted to a discussion board. The peers were trained with three additional computer modules and a _ day session on campus to provide support for improved diet and exercise behaviors in their class. Costs of intervention were calculated for each intervention group. The outcome variables were percentage dietary fat and physical activity measured by exercise log.
RESULTS: Costs for computerized model alone, were $39.89 per student. For computerized model plus Email feedback the costs were $53.12. And finally, computerized model plus peer feedback costs were $73.40. General Linear Model demonstrated a difference among groups for reducing dietary fat (p<0.037) with Email being the most effective, followed by peer feedback. Changes in physical activity showed significant interactions with gender (p=0.042), grade (p=0.036), and with gender, grade, and race (p=0.046) again with the Email approach being most effective. Computerized model and computerized model plus peer feedback approaches were effective for some, but not all subgroups.
CONCLUSION: Although computerized interventions were least expensive, those assisted by individualized Email most effectively decreased dietary fat intake and increased physical activity behaviors among middle school youth. Further refinement of the computer-tailored tool, based on gender, race, and grade, may improve its effectiveness.
