Promoting heart health in rural women. Results From an Intervention to Improve Rural Home Food and Physical Activity Environments Randomized Controlled Trial Targeting Obesity-Related Behaviors: Better Together Healthy Caswell County Adapting a natural (lay) helpers model of change for worksite health promotion for women. Effect of an Environmental School-based Obesity Prevention Program On Changes in Body Fat and Body Weight: A Randomized Trial The Colorado LEAP study: rationale and design of a study to assess the short term longitudinal effectiveness of a preschool nutrition and physical activity program Clinical Trial of Tailored Activity and Eating Newsletters With Older Rural Women Improving women's preconceptional health: findings from a randomized trial of the Strong Healthy Women intervention in the Central Pennsylvania women's health study. Making an IMPACT: effect of a school-based pilot intervention. The effect of physical education climates on elementary students' physical activity behaviors. Effects of a tailored health promotion program for female blue-collar workers: health works for women. Effects of a Physical Activity Intervention for Women The WORD (Wholeness, Oneness, Righteousness, Deliverance): A Faith-Based Weight-Loss Program Utilizing a Community-Based Participatory Research Approach Improving multiple behaviors for colorectal cancer prevention among african american church members. Louisiana (LA) Health: design and methods for a childhood obesity prevention program in rural schools. A Telephone-Only Motivational Intervention to Increase Physical Activity in Rural Adults: A Randomized Controlled Trial Framework for design and evaluation of complex interventions to improve health The WORD (Wholeness, Oneness, Righteousness, Deliverance): design of a randomized controlled trial testing the effectiveness of an evidence-based weight loss and maintenance intervention translated for a faith-based, rural, African American population using a community-based participatory approach. Maintenance of Activity and Eating Change After a Clinical Trial of Tailored Newsletters With Older Rural Women
PURPOSE To compare 2 strategies , stage-matched nursing and community intervention ( SMN+CI ) and community intervention ( CI ) alone in changing cardiovascular risk factors in up to 3 behavioral areas : diet , physical activity , and /or smoking among rural women . METHODS A 14-month , multisite r and omized controlled trial of 117 rural women was conducted . Transtheoretical model was used in identification of stage of change and development of the SMN+CI nursing interventions . A social-ecological model was used to address issues of rurality in the development of interventions . FINDINGS The SMN + CI group was superior on 4 outcomes . There were significant increases in 2 measures of dietary intake ; improvement in dietary stage of change for fruits and vegetables ; and reduced diastolic blood pressure ( DBP ) in the SMN + CI group . After log transformation DBP significance was lost . The CI group had a significant reduction in change in total cholesterol ; however , significance was lost after control for the initiation of lipid lowering medications . There was a significant reduction in Framingham risk scores pre- to postintervention , regardless of group . CONCLUSIONS There continues to be a need to improve cardiovascular risk factors in rural women . There should be an exploration of whether intensified dose and fidelity of the intervention strategies of diet and physical activity are effective in improving anthropometric and laboratory values . Further investigation is warranted into factors influencing the pre- to postreduction in Framingham risk scores Background : Ecological models of healthy eating and physical activity emphasize the influence of behavioral setting s such as homes and worksites in shaping behavior . Research on home environments suggests that both social and physical aspects of the home may impact physical activity and healthy eating . Objective : Using a community-based participatory research ( CBPR ) approach , the Emory Prevention Research Center ( EPRC ) , Cancer Coalition of South Georgia , and the EPRC 's Community Advisory Board ( CAB ) design ed and tested a coach-based intervention to make the home environment more supportive of healthy eating and physical activity for rural adults . Methods : The 6-week intervention consisted of a tailored home environment profile , goal - setting , and behavioral contracting delivered through two home visits and two telephone calls . The study used a quasi-experimental design with data collected via telephone interviews at baseline , 2 and 4 months post-baseline . Ninety households ( n = 90 ) completed all three telephone interviews . Results : Multilevel models indicated that intervention households reported significant improvements in household food inventories , purchasing of fruit and vegetables , healthier meal preparation , meals with the TV off , and family support for healthy eating , relative to comparison households . Intervention households also reported increased exercise equipment and family support for physical activity relative to comparison households . Percent of fat intake decreased significantly , but no changes were observed for fruit and vegetable intake , physical activity , or weight among intervention relative to comparison households , although trends were generally in a positive direction . Conclusion : Coaching combined with a focus on the home environment may be a promising strategy for weight gain prevention in adults Introduction Collaborative and multilevel interventions to effectively address obesity-related behaviors among rural communities with health disparities can be challenging , and traditional research approaches may be unsuitable . The primary objective of our 15-week r and omized controlled pilot study , which was guided by community-based participatory research ( CBPR ) principles , was to determine the effectiveness of providing twice-weekly access to group fitness classes , with and without weekly nutrition and physical activity education sessions , in Caswell County , North Carolina , a rural region devoid of medical and physical activity re sources . Methods Participants were r and omly divided into 2 groups : group 1 was offered fitness sessions and education in healthful eating and physical activity ; group 2 was offered fitness sessions only . Outcome measures were assessed at baseline and immediately after the intervention . St and ardized assessment procedures , vali date d measures , and tests for analysis of variance were used . Results Of 91 enrolled participants , most were African American ( 62 % ) or female ( 91 % ) . Groups were not significantly different at baseline . Group 1 experienced significantly greater improvements in body mass index ( F = 15.0 , P < .001 ) and waist circumference ( F = 7.0 , P = .01 ) , compared with group 2 . Both groups significantly increased weekly minutes of moderate physical activity ( F = 9.4 , P < .003 ) . Participants in group 1 also had significantly greater weight loss with higher attendance at the education ( F = 14.7 , P < .001 ) and fitness sessions ( F = 18.5 , P < .001 ) . Conclusion This study offers effective programmatic strategies that can reduce weight and increase physical activity and demonstrates feasibility for a larger scale CBPR obesity trial targeting underserved residents affected by health disparities . This study also signifies successful collaboration among community and academic partners engaged in a CBPR coalition Social network interventions that utilize informal systems of helping can be an important strategy for health promotion change . This article describes the development , implementation and evaluation of a natural ( lay ) helping intervention for health promotion change , specifically design ed for women in small rural blue-collar worksites . One hundred and four women in four intervention worksites were recruited as natural helpers , and received health and skill-building education over an 18-month period . Qualitative evaluation showed : ( 1 ) two patterns of natural helping for women , i.e. participation due to a specific health concern with either themselves or others in their personal networks , and participation due to a larger sense of the importance of health and prevention ; ( 2 ) over time natural helpers exp and ed the diffusion of health promotion information from close network members to co-workers and were more likely to be approached by their co-workers for information ; ( 3 ) group activities at the worksite , particularly around physical activity , increased over time ; and ( 4 ) because of time constraints at the workplace , written material s were a major way of spreading information to co-workers . This study shows that women can be recruited and trained to diffuse health promotion information and provide support to co-workers for health behavior change This study tested the efficacy of two school-based programs for prevention of body weight/fat gain in comparison to a control group , in all participants and in overweight children . The Louisiana ( LA ) Health study utilized a longitudinal , cluster r and omized 3-arm controlled design , with 28 months of follow-up . Children ( N=2060 ; M age = 10.5 years , SD = 1.2 ) from rural communities in Grade s 4 to 6 participated in the study . 17 school clusters ( M = 123 children/cluster ) were r and omly assigned to one of three prevention arms : 1 ) Primary Prevention ( PP ) , an environmental modification program , 2 ) Primary + Secondary Prevention ( PP+SP ) , the environmental program with an added classroom and internet education component , or 3 ) Control ( C ) . Primary outcomes were changes in percent body fat and body mass index z scores . Secondary outcomes were changes in behaviors related to energy balance . Comparisons of PP , PP+SP , and C on changes in body fat and BMI z scores found no differences . PP and PP+SP study arms were combined to create an environmental modification arm ( EM ) . Relative to C , EM decreased body fat for boys ( −1.7 % ± 0.38 % versus −0.14 % ± 0.69 % ) and attenuated fat gain for girls ( 2.9 % ± 0.22 % versus 3.93 % ± 0.37 % ) , but st and ardized effect sizes were relatively small ( < 0.30 ) . In conclusion , this school-based environmental modification programs had modest beneficial effects on changes in percent body fat . Addition of a classroom/internet program to the environmental program did not enhance weight/fat gain prevention , but did impact physical activity and social support in overweight children Background The preschool years are a critical window for obesity prevention efforts ; representing a time when children establish healthy eating habits and physical activity patterns . Underst and ing the context in which these behaviors develop is critical to formulating a model to address childhood obesity . The Colorado LEAP Study , an intervention study design ed to prevent early childhood obesity , utilizes a social ecological approach to explore individual , family and environmental factors and their relationship to child weight status over a 3 year timeframe . Methods The study is located in 5 rural Colorado preschool centers and elementary schools ( 2 treatment and 3 control ) . Treatment sites receive The Food Friends ® nutrition ( 12 weeks ) and physical activity ( 18 weeks ) interventions during preschool . Observational measures assess 3 layers of the social ecological model including individual , family and organizational inputs . Children ’s food preferences , food intake , gross motor skills , physical activity ( pedometers/accelerometers ) , cognitive , physical and social self-competence and height/weight are collected . Parents provide information on feeding and activity practice s , child ’s diet , oral sensory characteristics , food neophobia , home food and activity environment , height/weight and physical activity ( pedometers ) . School personnel complete a school environment and policy assessment . Measurements are conducted with 3 cohorts at 4 time points – baseline , post-intervention , 1- and 2-year follow-up . Discussion The design of this study allows for longitudinal exploration of relationships among eating habits , physical activity patterns , and weight status within and across spheres of the social ecological model . These methods advance traditional study design s by allowing not only for interaction among spheres but predictively across time . Further , the recruitment strategy includes both boys and girls from ethnic minority population s in rural areas and will provide insights into obesity prevention effects on these at risk population s . Trial registration Clinical Trials.gov : NCT01937481 Background : Unhealthy diet and lack of physical activity increase rural midlife and older women 's risk of chronic diseases and premature death , and they are behind urban residents in meeting Healthy People 2010 objectives . Objectives : The objective of this study was to compare a tailored intervention based on the Health Promotion Model with a generic intervention to increase physical activity  and  healthy eating  among rural women . Methods : In a r and omized-by-site , community-based , controlled , clinical trial , Wellness for Women , 225 women aged 50 to 69 years were recruited in two similar rural areas . Over 12 months , women received by mail either 18 generic newsletters or 18 newsletters computer tailored on Health Promotion Model behavior-specific cognitions ( benefits , barriers , self-efficacy , and interpersonal support ) , activity , and eating . Outcomes at 6 and 12 months included behavioral markers and biomarkers of physical activity and eating . Data were analyzed by repeated- measures analysis of variance and chi-square tests ( & agr ; < .05 ) . Results : Both groups significantly increased stretching and strengthening exercise and fruit and vegetable servings and decreased percentage of calories from fat , whereas only the tailored group increased moderate or greater intensity activity and decreased percentage of calories from saturated fat from baseline to 6 months . Both groups increased stretching and strengthening exercise , whereas only the tailored group increased moderate or greater intensity activity and fruit and vegetable servings and decreased percentage of calories from fat from baseline to 12 months . Both groups had several changes in biomarkers over the study . A higher proportion of women receiving tailored newsletters met Healthy People 2010 criteria for moderate or greater intensity activity , fruit and vegetable servings , and percentage of calories from fat at 12 months . Discussion : Mailed computer-tailored and generic print newsletters facilitated the adoption of change in both activity and eating over 6 months . Tailored newsletters were more efficacious in facilitating change over 12 months PURPOSE Improving the health of women before pregnancy is an important strategy for reducing adverse pregnancy outcomes for mother and child . This paper reports the first pretest-posttest results from a r and omized trial of a unique , multidimensional , small group format intervention , Strong Healthy Women , design ed to improve the health behaviors and health status of preconceptional and interconceptional women . METHODS Nonpregnant pre- and interconceptional women ages 18 - 35 were recruited in 15 low-income rural communities in Central Pennsylvania ( n = 692 ) . Women were r and omized in a ratio of 2-to-1 to intervention and control groups ; participants received a baseline and follow-up health risk assessment at 14 weeks and completed question naires to assess behavioral variables . The analytic sample for this report consists of 362 women who completed both risk assessment s. Outcomes include measures of attitudinal and health-related behavior change . MAIN FINDINGS Women in the intervention group were significantly more likely than controls to report higher self-efficacy for eating healthy food and to perceive higher preconceptional control of birth outcomes ; greater intent to eat healthy foods and be more physically active ; and greater frequency of reading food labels , physical activity consistent with recommended levels , and daily use of a multivitamin with folic acid . Significant dose effects were found : Each additional intervention session attended was associated with higher perceived internal preconceptional control of birth outcomes , reading food labels , engaging in relaxation exercise or meditation for stress management , and daily use of a multivitamin with folic acid . CONCLUSIONS The attitudinal and behavior changes attributable to the intervention were related primarily to nutrition and physical activity . These results show that these topics can be successfully addressed with pre- and interconceptional women outside the clinical setting in community-based interventions BACKGROUND Poor nutrition and inactivity are widespread and contribute to the epidemic problem of childhood obesity . This study examined the effectiveness of a school-based pilot program to improve nutrition and activity in elementary ( ES ) and high school ( HS ) students . METHODS The Improving Meals and Physical Activity in Children and Teens ( IMPACT ) school-based curriculum used a train-the-trainer model to improve activity and nutrition . Nine students were recruited from one rural North Carolina high school and trained in the IMPACT curriculum and leadership skills . Four 4th grade classes at a neighboring elementary school were r and omized to receive the IMPACT curriculum delivered by the  HS students over 12 weeks ( two classrooms , 38 students ) versus the st and ard curriculum ( two classrooms , 37 students ) . Pre- and post-intervention surveys were used to assess program effectiveness . RESULTS ES students in the intervention classes reported increased fruit and vegetable intake ( + 0.85 servings/day compared with controls ; p < 0.05 ) and improved knowledge of the food group in which to eat the most servings ( p < 0.01 ) . ES students who participated in the IMPACT curriculum also reported increased intake of calcium-rich foods and grains , though these results were not statistically significant . Similar though nonsignificant improvements in diet behaviors were reported by the HS students who assisted in delivering the 4th grade curriculum . LIMITATIONS Study limitations include small sample size , risk of cross-contamination , and short program duration . CONCLUSIONS ES students who participated in the IMPACT curriculum reported improved dietary behaviors and knowledge . School-based curricula such as IMPACT may help improve nutrition among ES students BACKGROUND With the growing need for children from underserved population s to be physically active it is imperative to create developmentally appropriate and enjoyable physical education programs that promote physical activity . The purpose of this study was to determine the effects of mastery and performance climates on physical activity during physical education . METHODS Children ( N = 108 ) in grade s K-2 from a rural southeastern elementary school in the United States were r and omly assigned to a mastery- or performance-oriented climate . The climates were implemented over 10 school days during regular scheduled physical education classes , and  physical activity  was measured with pedometers and system for observing fitness instruction time ( SOFIT ) . Two experts in mastery motivational climates served as teachers for the study and were counterbalanced between conditions . RESULTS Results showed that steps/minute were significantly higher for the mastery condition , and participants in the mastery condition spent significantly less time sitting ( p < .001 ) and in management ( p < .001 ) and more time in moderate-to-vigorous physical activity ( MVPA ; p = .002 ) and fitness activities ( p = .001 ) . CONCLUSION Results indicate that a mastery approach , which allows children the opportunity to drive their own physical activity , elicits higher step counts and more time spent in MVPA compared with a performance-oriented approach BACKGROUND This study assessed the effects of the Health Works for Women ( HWW ) intervention on improving multiple behaviors including nutrition and physical activity among rural female blue-collar employees in North Carolina . METHODS Nine small to mid-size workplaces were r and omly assigned to either intervention or delayed intervention conditions . After a baseline survey , an intervention consisting of two computer-tailored magazines and a natural helpers program was conducted over 18 months . Delayed worksites received one tailored magazine . Approximately 77 and 76 % of baseline respondents completed follow-up surveys at 6 and 18 months , respectively , and 538 women ( 63 % ) completed all three surveys . RESULTS At the 18-month follow-up , the intervention group had increased fruit and vegetable consumption by 0.7 daily servings compared to no change in the delayed group ( P < 0.05 ) . Significant differences in fat intake were observed at 6 months ( P < 0.05 ) but not at 18 months . The intervention group also demonstrated improvements in strengthening and flexibility exercise compared to the delayed group . The rates of smoking cessation and cancer screening did not differ between study groups . CONCLUSIONS The HWW project was a successful model for achieving certain health behavior changes among blue-collar women Physical activity is associated with health and reduced mortality risk , yet only15 % ofU.S. adults achieve adequate activity . This study is an experimental repeated measures nested design r and omizing two similar rural communities to investigate the effectiveness of the Heart and Soul Physical Activity Program ( HSPAP ) ( Peterson , 2002 ) in promoting physical activity in midlife women ( n = 42 ) aged 35 to 65 years . The HSPAP , an innovative church-based health promotion intervention , is conceptualized in social support and design ed to increase physical activity , energy expenditure ( EE ) , and cardiorespiratory fitness ( VO2 max ) , measured over time . A significant interaction ( p < .001 ) was found for EE in one HSPAP group increasing their EE by 1,010 kcals/week . HSPAP participants increased their VO2 max level by 75 % ( p < .001 ) and 10 % ; comparison groups stayed the same or declined 16 % . Study results provide preliminary support for the HSPAP intervention as an effective treatment to improve physical activity levels in sedentary , rural , midlife women Despite multidisciplinary efforts to control the nation 's obesity epidemic , obesity has persisted as one of the U.S. 's top public health problems , particularly among African Americans . Innovative approaches to address obesity that are sensitive to the unique issues of African Americans are needed . Thus , a faith-based weight-loss intervention using a community-based participatory research approach was developed , implemented , and evaluated with a rural African American faith community . A two-group , quasi-experimental , delayed intervention design was used , with church as the unit of assignment ( treatment n = 2 , control n = 2 ) and individual as the unit of observation ( treatment n = 36 , control n = 37 ) . Weekly small groups led by trained community members met for 8 weeks and emphasized healthy nutrition , physical activity , and faith 's connection with health . The mean weight loss of the treatment group was 3.60 ± 0.64 lbs . compared to the 0.59 ± 0.59-lb loss of the control group The WATCH ( Wellness for African Americans Through Churches ) Project was a r and omized trial comparing the effectiveness of 2 strategies to promote colorectal cancer preventive behaviors among 587 African American members of 12 rural North Carolina churches . Using a 2 X 2 factorial research design , the authors compared a tailored print and video ( TPV ) intervention , consisting of 4 individually tailored newsletters and targeted videotapes , with a lay health advisor ( LHA ) intervention . Results showed that the TPV intervention significantly improved ( p < .05 ) fruit and vegetable consumption ( 0.6 servings ) and recreational physical activity ( 2.5 metabolic task equivalents per hour ) and , among those 50 and older ( n = 287 ) , achieved a 15 % increase in fecal occult blood testing screening ( p = .08 ) . The LHA intervention did not prove effective , possibly because of suboptimal reach and diffusion There is a worldwide epidemic of obesity with far-reaching consequences for the health of our nation . Prevention of obesity , especially in children , has been deemed by public health policy makers to be one of the most important objectives for our country . This prevention project , called Louisiana ( LA ) Health , will test whether modification of environmental and behavioral factors can prevent inappropriate weight gain in children from rural parishes of Louisiana who are enrolled in the fourth to sixth grade s during Year 1 . The primary aim of the LA Health project is to test the efficacy of two school-based approaches for  obesity prevention : primary prevention alone and a combination of primary and secondary prevention which will be compared to a no-intervention control group using a cluster r and omization research design , with 17 school clusters r and omly assigned to the three treatment arms . The study will span 3 years and will provide critical tests of strategies that : 1 ) modify the child 's environment as a primary prevention strategy and 2 ) provide health behavior modification via classroom instruction and internet counseling as a secondary prevention strategy . The study will also recruit a similar sample of students to measure changes in body weight relative to height , gender , and age over the same three-year period Background : Both urban and rural adults are likely to be inactive , but rural adults have less access to exercise classes or facilities to increase physical activity . Objectives : To evaluate whether a telephone-only motivational interviewing ( MI ) intervention would increase daily physical activity of rural adults . Methods : This r and omized controlled trial enrolled 86 physically inactive adults living in rural communities ( mean age = 58 years , range = 30 - 81 years ) who stated that they were ready to increase physical activity during the next 6 months . Participants were assigned r and omly to  MI intervention ( n = 43 ) or  control ( n = 43 ) groups . The MI group participants received a pedometer and monthly MI telephone calls over 6 months from a counselor . Control group participants received an equal number of telephone calls without MI content .  Physical activity was measured by self-report using the Community Healthy Activities Model Program For Seniors Physical Activity Question naire for Older Adults . Data were collected by mailed surveys and analyzed using analysis of variance . Results : Seventy-two participants completed the study ( 35 in the intervention group and 37 in the control group ) . The telephone-only MI intervention increased self-efficacy for exercise ( p = .019 ) but did not increase levels of physical activity ( p = .572 ) compared with controls . Discussion : The intervention increased self-efficacy for exercise but did not increase physical activity , possibly due to seasonal effects , the control condition , or the length of the MI intervention . Even so , future studies are warranted because telephone-only MI has potential as a practical , relatively inexpensive method to provide health counseling to rural adults in a broad geographic area . This study produced an effect size on physical activity that will be useful to guide future studies R and omised controlled trials are widely accepted as the most reliable method of determining effectiveness , but most trials have evaluated the effects of a single intervention such as a drug . Recognition is increasing that other , non-pharmacological interventions should also be rigorously evaluated.1 - 3 This paper examines the design and execution of research required to address the additional problems result ing from evaluation of complex interventions —that is , those “ made up of various interconnecting parts.”4 The issues dealt with are discussed in a longer Medical Research Council paper ( www.mrc.ac.uk/complex_packages.html ) . We focus on r and omised trials but believe that this approach could be adapted to other design s when they are more appropriate . # # # # Summary points Complex interventions are those that include several components The evaluation of complex interventions is difficult because of problems of developing , identifying , documenting , and reproducing the intervention A phased approach to the development and evaluation of complex interventions is proposed to help research ers define clearly where they are in the research process Evaluation of complex interventions requires use of qualitative and quantitative evidence There are specific difficulties in defining , developing , documenting , and reproducing complex interventions that are subject to more variation than a drug . A typical example would be the design of a trial to evaluate the  benefits of specialist stroke units .  Such a trial would have to consider the expertise of various health professionals as well as investigations , drugs , treatment guidelines , and arrangements for discharge and follow up . Stroke units may also vary in terms of organisation , management , and skill mix . The active components of the stroke unit may be difficult to specify , making it difficult to replicate the intervention . The box gives other examples of complex interventions . # # # # Examples of complex interventions Service delivery and organisation : Stroke units Hospital at home Interventions directed at health professionals ' behaviour : Strategies for implementing guidelines Computerised decision support Community interventions : Community BACKGROUND The positive effects of weight loss on obesity-related risk factors diminish unless weight loss is maintained . Yet little work has focused on the translation of evidence -based weight loss interventions with the aim of sustaining weight loss in underserved population s. Using a community-based participatory approach ( CBPR ) that engages the strong faith-based social infrastructure characteristic of rural African American communities is a promising way to sustain weight loss in African Americans , who bear a disproportionate burden of the obesity epidemic . OBJECTIVES Led by a collaborative community-academic partnership , The WORD aims to change dietary and physical activity behaviors to produce and maintain weight loss in rural , African American adults of faith . DESIGN The WORD is a r and omized controlled trial with 450 participants nested within 30 churches . All churches will receive a 16-session core weight loss intervention . Half of the churches will be r and omized to receive an additional 12-session maintenance component . METHODS The WORD is a cultural adaptation of the Diabetes Prevention Program , whereby small groups will be led by trained church members . Participants will be assessed at baseline , 6 , 12 , and 18 months . A detailed cost-effectiveness and process evaluation will be included . SUMMARY The WORD aims to sustain weight loss in rural African Americans . The utilization of a CBPR approach and the engagement of the faith-based social infrastructure of African American communities will maximize the intervention 's sustainability . Unique aspects of this trial include the focus on weight loss maintenance and the use of a faith-based CBPR approach in translating evidence -based obesity interventions Background : In the Wellness for Women Project , a r and omized-by-site 1-year controlled clinical trial , the efficacy of generic newsletters and newsletters tailored on Health Promotion Model behavior-specific cognitions , eating behavior , and activity behavior were compared among 225 women aged 50 to 69 years . Objectives : The purpose of this study was to compare the maintenance of change in healthy eating and physical activity over the 12 months following the tailored versus generic mailed newsletter intervention . Methods : Outcomes at 18 and 24 months included behavioral markers and biomarkers of physical activity and eating . Data were analyzed using the multivariate approach to repeated measures analysis of variance and generalized estimating equations ( α < .05 ) . Results : At 18 months , the tailored group maintained levels of all eating and activity behaviors , whereas the generic group maintained levels of fruit and vegetable servings , a moderate or greater activity , stretching exercise , lower body strength and flexibility but increased saturated fat intake and declined in weekly strength exercise and cardiorespiratory fitness . At 24 months , both groups maintained or returned to 12-month levels of all eating behaviors , moderate or greater activity , stretching exercise , and flexibility but declined in cardiorespiratory fitness ; the tailored group maintained levels of strength exercise and lower body strength , whereas the generic group decreased in both . A greater proportion of women who received tailored newsletters continued to achieve most Healthy People 2010 criteria for eating and activity . Discussion : Mailed tailored print newsletters were more efficacious than generic newsletters in facilitating maintenance of change in eating and activity for 6 months postintervention . Both tailored and generic newsletters facilitated the maintenance of change in eating behaviors and in moderate or greater physical activity and stretching exercise , whereas tailored newsletters were more efficacious in maintaining change in strength exercise for 12 months postintervention
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