A factorial-design cluster randomised controlled trial investigating the cost-effectiveness of a nutrition supplement and an exercise programme on pneumonia incidence, walking capacity and body mass index in older people living in Santiago, Chile: the CENEX study protocol Efficacy and cost-effectiveness of a clinic-based counseling intervention tested in an ethnically diverse sample of pregnant smokers. Mortality in relation to smoking: 50 years' observations on male British doctors Free nicotine patches plus proactive telephone peer support to help low-income women stop smoking. A Stage-Targeted Physical Activity Intervention among a Predominantly African-American Low-Income Primary Care Population Evidence-based behavioral medicine: What is it and how do we achieve it? Effectiveness of different methods for delivering tailored nutrition education to low income, ethnically diverse adults A brief smoking cessation intervention for Chinese and Korean American smokers. Promoting physical activity for low-income minority women in primary care. Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial. Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial Using a quitline plus low-cost nicotine replacement therapy to help disadvantaged smokers to quit A randomized, controlled trial of financial incentives for smoking cessation. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Design and outcomes of a Mothers In Motion behavioral intervention pilot study. Effectiveness of a cognitive behaviour therapy self-help programme for smokers in London, UK. Participant recruitment and retention in a pilot program to prevent weight gain in low-income overweight and obese mothers A culturally adapted physical activity intervention for Latinas: a randomized controlled trial. Culturally Tailored Aerobic Exercise Intervention for Low-Income Latinas Baby BEEP: A Randomized Controlled Trial of Nurses’ Individualized Social Support for Poor Rural Pregnant Smokers Cause specific mortality, social position, and obesity among women who had never smoked: 28 year cohort study A Stage-Tailored Multi-Modal Intervention Increases Fruit and Vegetable Intakes of Low-Income Young Adults Results of the Heart Healthy and Ethnically Relevant Lifestyle trial: a cardiovascular risk reduction intervention for African American women attending community health centers. Long-term effects of a communication intervention for Spanish-dominant Latinas. Cancer prevention among working class, multiethnic adults: results of the healthy directions-health centers study. Pathway to health: cluster-randomized trial to increase fruit and vegetable consumption among smokers in public housing. Combining community participatory research with a randomized clinical trial: the Protecting the Hood Against Tobacco (PHAT) smoking cessation study. A volitional help sheet to increase physical activity in people with low socioeconomic status: A randomised exploratory trial Tobacco cessation via public dental clinics: results of a randomized trial. Linking clinical care to community resources for cardiovascular disease prevention: the North Carolina Enhanced WISEWOMAN project. Randomized trial of a clinic-based, community-supported, lifestyle intervention to improve physical activity and diet: the North Carolina enhanced WISEWOMAN project. The effect of a culturally tailored smoking cessation for Chinese American smokers. Effectiveness of a nutrition intervention with rural low-income women. Preventing postpartum smoking relapse among diverse low-income women: a randomized clinical trial. Pathways to Health: A Cluster Randomized Trial of Nicotine Gum and Motivational Interviewing for Smoking Cessation in Low-Income Housing Parent quit attempts after counseling to reduce children's secondhand smoke exposure and promote cessation: main and moderating relationships. The Seamos Saludables study: A randomized controlled physical activity trial of Latinas. Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers: a randomized controlled trial.
Background Chile is currently undergoing a period of rapid demographic transition which has led to an increase in the proportion of older people in the population ; the proportion aged 60 years and over , for example , increased from 8 % of the population in 1980 to 12 % in 2005 . In an effort to promote healthy ageing and preserve function , the government of Chile has formulated a package of actions into the Programme of Complementary Feeding for the Older Population ( PACAM ) which has been providing a nutritional supplement to older people since 1998 . PACAM distributes micronutrient fortified foods to individuals aged 70 years and over registered at Primary Health Centres and enrolled in the programme . The recommended serving size ( 50 g/day ) of these supplements provides 50 % of daily micronutrient requirements and 20 % of daily energy requirements of older people . No information is currently available on the cost-effectiveness of the supplementation programme . Aim The aim of the CENEX cluster r and omised controlled trial is to evaluate the cost-effectiveness of an ongoing nutrition supplementation programme , and a specially design ed physical exercise intervention for older people of low to medium socio-economic status living in Santiago , Chile . Methods The study has been conceptualised as a public health programme effectiveness study and has been design ed as a 24-month factorial cluster-r and omised controlled trial conducted among 2800 individuals aged 65.0–67.9 years at baseline attending 28 health centres in Santiago . The main outcomes are incidence of pneumonia , walking capacity and change in body mass index over 24 months of intervention . Costing data ( user and provider ) , collected at all levels , will enable the determination of the cost-effectiveness of the two interventions individually and in combination . The study is supported by the Ministry of Health in Chile , which is keen to exp and and improve its national programme of nutrition for older people based on sound science-base and evidence for cost-effectiveness . Trial registration IS RCT OBJECTIVE Rates of cigarette smoking are higher among women who receive obstetric care through publicly funded prenatal clinics . This study compared smoking outcomes for pregnant women ( n=105 ) who were r and omized to receive either usual care ( st and ard cessation advice from the health care provider ) or an intervention conducted in the prenatal clinic consisting of 1.5 h of counseling plus telephone follow-up delivered by a masters prepared mental health counselor . METHODS Subjects were 105 low income , predominantly Hispanic , pregnant patients in an urban prenatal clinic .  Smoking outcomes were assessed at end of pregnancy and 6 months post-partum . RESULTS At follow-up , 28.3 % and 9.4 % of participants in the experimental intervention and 9.6 % and 3.8 % of patients in usual care were abstinent at end of pregnancy ( p=.015 ) and 6 months post-partum , respectively ( p=.251 ) . Cost of the intervention was $ 56 per patient and cost to produce a non-smoker at end of pregnancy was $ 299 . CONCLUSIONS This model for intervention was cost-effective and was associated with significantly lower smoking rates at end of pregnancy . PRACTICAL IMPLICATION S If these findings are replicated , prenatal clinics could offer the option for intensive smoking cessation treatment by training mental health counselors to deliver one extended smoking cessation counseling session Abstract Objective To compare the hazards of cigarette smoking in men who formed their habits at different periods , and the extent of the reduction in risk when cigarette smoking is stopped at different ages . Design Prospect i ve study that has continued from 1951 to 2001 . Setting United Kingdom . Participants 34 439 male British doctors . Information about their smoking habits was obtained in 1951 , and periodically thereafter ; cause specific mortality was monitored for 50 years . Main outcome measures Overall mortality by smoking habit , considering separately men born in different periods . Results The excess mortality associated with smoking chiefly involved vascular , neoplastic , and respiratory diseases that can be caused by smoking . Men born in 1900 - 1930 who smoked only cigarettes and continued smoking died on average about 10 years younger than lifelong non-smokers . Cessation at age 60 , 50 , 40 , or 30 years gained , respectively , about 3 , 6 , 9 , or 10 years of life expectancy . The excess mortality associated with cigarette smoking was less for men born in the 19th century and was greatest for men born in the 1920s . The cigarette smoker versus non-smoker probabilities of dying in middle age ( 35 - 69 ) were 42 % ν24 % ( a twofold death rate ratio ) for those born in 1900 - 1909 , but were 43 % ν 15 % ( a threefold death rate ratio ) for those born in the 1920s . At older ages , the cigarette smoker versus non-smoker probabilities of surviving from age 70 to 90 were 10 % ν 12 % at the death rates of the 1950s ( that is , among men born around the 1870s ) but were 7 % ν 33 % ( again a threefold death rate ratio ) at the death rates of the 1990s ( that is , among men born around the 1910s ) . Conclusion A substantial progressive decrease in the mortality rates among non-smokers over the past half century ( due to prevention and improved treatment of disease ) has been wholly outweighed , among cigarette smokers , by a progressive increase in the smoker ν non-smoker death rate ratio due to earlier and more intensive use of cigarettes . Among the men born around 1920 , prolonged cigarette smoking from early adult life tripled age specific mortality rates , but cessation at age 50 halved the hazard , and cessation at age 30 avoided almost all of it BACKGROUND This study tested the impact of free nicotine patches plus proactive telephone peer support to help low-income women stop smoking . METHODS A total of 214 Medicaid-eligible women smokers of childbearing age were r and omized to receive free nicotine patches through the mail or free nicotine patches through the mail plus the provision of proactive support by telephone from a woman ex-smoker for up to 3 months . Assessment s were conducted by telephone at baseline , 10 days , and 3 and 6 months after enrollment . RESULTS At the 3-month follow-up , significantly more women in the patch plus proactive telephone support condition were abstinent ( 42 % ) compared to the patch only condition ( 28 % ) ( P = 0.03 ) . Similarly , more women in the experimental condition were abstinent at both the 10-day and 3-month assessment s ( 32 v 19 % , P = 0.02 ) . However , differences were not found at the 6-month follow-up , suggesting that the addition of proactive telephone peer support enhanced short-term , but not long-term cessation . CONCLUSIONS This is the first study to demonstrate a beneficial effect for the addition of proactive telephone support as an adjunct to free nicotine replacement in a low-income population Purpose . To examine the efficacy of a stage-targeted physical activity intervention among low-income African-Americans . Methods . 207 participants were r and omly assigned to groups and administered baseline measures . Intervention participants were mailed stage-targeted physical activity information , whereas control participants received low-sodium diet brochures . Measures were readministered by phone 1 and 6 months later , with response rates of 69 % and 46 % , respectively . Results . 69 % of participants were African-American and 64 % had a monthly household income of < $ 1000 . A doubly-multivariate analysis of variance indicated that intervention participants reported more physical activity than control participants at 1 month ( F(1 , 204 ) = 4.03 , p < .05 ) . Unlike control participants , intervention participants reported significant stage progression at 1 month , according to a McNemar χ2 test . Gains attenuated by 6 months . Conclusions . The current study supports the use of this intervention among low-income African-Americans . Limitations include use of self-report measures and small sample size The goal of evidence -based medicine is ultimately to improve patient outcomes and quality of care .  Systematic review s of the available published evidence are required to identify interventions that lead to improvements in behavior , health , and well-being . Authoritative literature review s depend on the quality of published research and research reports . The Consoli date d St and ards for Reporting Trials ( CONSORT ) Statement ( www.consort-statement.org ) was developed to improve the design and reporting of interventions involving r and omized clinical trials ( RCTs ) in medical journals . We describe the 22 CONSORT guidelines and explain their application to behavioral medicine research and to evidence -based practice . Additional behavioral medicine-specific guidelines ( e.g. , treatment adherence ) are also presented . Use of these guidelines by clinicians , educators , policymakers , and research ers who design , report , and evaluate or review RCTs will strengthen the research itself and accelerate efforts to apply behavioral medicine research to improve the processes and outcomes of behavioral medicine practice Background Computer-tailored written nutrition interventions have been shown to be more effective than non-tailored material s in changing diet , but continued research is needed . Your Healthy Life/Su Vida Saludable ( YHL-SVS ) was an intervention study with low income , ethnically diverse , English and Spanish-speaking participants to determine which methods of delivering tailored written nutrition material s were most effective in lowering fat and increasing fruit and vegetable ( F&V ) intake . Methods YHL-SVS was a r and omized controlled trial with four experimental conditions : 1 )  Nontailored ( NT ) comparison group ; 2 ) Single Tailored ( ST ) packet ; 3 ) Multiple Tailored ( MT ) packet mailed in four installments ; 4 ) Multiple Re-Tailored ( MRT ) MT packets re-tailored between mailings via brief phone surveys . A baseline telephone survey collected information for tailoring as well as evaluation . Follow-up evaluation surveys were collected 4- and 7-months later . Primary outcomes included F&V intake and fat related behaviors . Descriptive statistics , paired t-test and ANOVA were used to examine the effectiveness of different methods of delivering tailored nutrition information . Results Both the ST and MT groups reported significantly higher F&V intake at 4-months than the NT and MRT groups . At 7 months , only the MT group still had significantly higher F&V intake compared to the NT group . For changes in fat-related behaviors , both the MT and MRT groups showed more change than NT at 4 months , but at 7 months , while these differences persisted , they were no longer statistically significant . There was a significant interaction of experimental group by education for change in F&V intake ( P = .0085 ) with the lowest educational group demonstrating the most change . Conclusion In this study , tailored interventions were more effective than non-tailored interventions in improving the  short-term dietary behaviors of low income , ethnically diverse participants . Delivery of information in multiple smaller doses over time appeared to improve effectiveness . Future studies should determine which variables are mediators of dietary change and whether these differ by participant demographics . Moreover , future research should differentiate the effects of tailoring vs. cultural adaptation in ethnically diverse population s and study the dissemination of tailored interventions into community-based setting s . Trial registration Current Controlled Trials # NCT00301691 OBJECTIVE This study evaluated changes in smoking-related beliefs and behavior following a brief , culturally adapted smoking cessation intervention for Chinese and Korean smokers . METHOD From May 2002 to March 2003 , 66 smokers residing in or around southeastern Pennsylvania were r and omly assigned to a theory-based smoking cessation intervention or general health counseling . Participants completed assessment s of perceived risks of smoking , pros and cons of quitting , quitting self-efficacy , and distress at baseline and follow-up time points . Sessions were conducted in the participant 's native language ( Korean , Cantonese , or M and arin ) . Both groups received nicotine replacement therapy . RESULTS Overall , 38 % of participants reported quitting smoking at 3-month follow-up . Quit rates were higher ( 52.6 % among Chinese , 60.0 % among Korean ) in the intervention condition compared to the control condition ( 23.5 % among Chinese , 40.0 % among Korean ) at 1-month , but not 3-month , follow-up . There was a main effect of treatment condition for self-efficacy with intervention participants reporting significantly higher levels of self-efficacy compared to control participants . Further , a treatment x time interaction was observed for cons of quitting , reflecting fewer cons in the intervention group than the control group at 1-month and 3-month follow-up . CONCLUSION A culturally adapted intervention for Chinese and Korean Americans can be effective in changing specific smoking-related cognitions and behavior . This study represents a promising first step toward advancing our underst and ing of the associations between smoking-related cognitions and behavior among Asian American smokers OBJECTIVE To examine the effects of a primary -care weight management intervention on physical activity ( PA ) among overweight/obese women . METHODS This r and omized controlled trial included 139 women ( 92 % African American ) . The effects of a physician-delivered tailored intervention were compared with st and ard care . Repeated measures analyses of variance ( ANOVA ) were used to examine changes in PA ( measured by a 7-day physical activity recall ) and physical fitness ( measured by heart rate recovery following exercise ) . RESULTS Although the intervention group demonstrated an increase in PA , this did not differ significantly from st and ard care . A significantly greater proportion of intervention participants ( 90 % ) achieved current PA recommendations compared with st and ard care ( 77 % ) , P<.03 . CONCLUSION These results provide novel information suggesting that a physician-delivered intervention may have limited effectiveness for increasing PA among this at-risk population OBJECTIVE To determine if an interactive , computerized Video Doctor counseling tool improves self-reported diet and exercise in pregnant women . METHODS A r and omized trial comparing a Video Doctor intervention to usual care in ethnically diverse , low-income , English-speaking pregnant women was conducted . Brief messages about diet , exercise , and weight gain were delivered by an actor-portrayed Video Doctor twice during pregnancy . RESULTS In the  Video Doctor group ( n=158 ) , there were statistically significant increases from baseline in exercise ( + 28 min ) , intake of fruits and vegetables , whole grains , fish , avocado and nuts , and significant decreases in intake of sugary foods , refined grains , high fat meats , fried foods , solid fats , and fast food . In contrast , there were no changes from baseline for any of these outcomes in the usual care group ( n=163 ) . Nutrition knowledge improved significantly over time in both groups but more so in the Video Doctor group . Clinician-patient discussion s about these topics occurred significantly more frequently in the Video Doctor group . There was no difference in weight gain between groups . CONCLUSION A brief Video Doctor intervention can improve exercise and dietary behaviors in pregnant women . PRACTICE IMPLICATION S The Video Doctor can be integrated into prenatal care to assist clinicians with effective diet and exercise counseling Abstract Objective : To measure the effect of brief behavioural counselling in general practice on patients ' consumption of fruit and vegetables  in adults from a low income population . Design : Parallel group r and omised controlled trial . Setting : Primary health centre in a deprived , ethnically mixed inner city area . Participants : 271 patients aged 18 - 70 years without serious illness . Intervention : Brief individual behavioural counselling based on the stage of change model ; time matched nutrition education counselling . Main outcome measures : Self reported number of portions of fruit and vegetables eaten per day , plasma β carotene , α tocopherol , and ascorbic acid concentrations , and 24 hour urinary potassium excretion . Assessment at baseline , eight weeks , and 12 months . Results : Consumption of fruit and vegetables increased from baseline to 12 months by 1.5 and 0.9 portions per day in the behavioural and nutrition groups ( mean difference 0.6 portions , 95 % confidence interval 0.1 to 1.1 ) . The proportion of participants eating five or more portions a day increased by 42 % and 27 % in the two groups ( mean difference 15 % , 3 % to 28 % ) . Plasma β carotene and α tocopherol concentrations increased in both groups , but the rise in β carotene was greater in the behavioural group ( mean difference 0.16 µmol/l , 0.001 µmol/l to 1.34 µmol/l ) . There were no changes in plasma ascorbic acid concentrations or urinary potassium excretion . Differences were maintained when analysis was restricted to the 177 participants with incomes £ 400 ( € 596 , $ 640 ) a week . Conclusions : Brief individual counselling in primary care can elicit sustained increases in consumption of fruit and vegetables in low income adults in the general population . What is already known on this topic Brief interventions can be effective in increasing consumption of fruit and vegetables Biomarkers and intention to treat analyses have seldom been used in such interventions , and few studies have targeted low income population s What this study adds Compared with nutritional counselling , brief behavioural counselling carried out by nurses in primary care led to greater increases in fruit and vegetable intake and in plasma β carotene concentration Favourable effects were observed in low income adults living in a deprived inner city Objectives : To trial an intervention in a real-life setting to motivate low-income smokers to try to quit . The intervention under trial was the addition of subsidised nicotine replacement therapy ( NRT ) to a st and ard population quitline service . Design : Participants were low-income smokers , recruited “ cold ” via either a letter in the mail or a flyer inserted in a local newspaper . The intervention group received the usual service of multisession counselling from the quitline plus access to heavily subsidised NRT . A comparison group received the usual quitline service only . Participants were followed up at 3 , 6 , and 12 months . Trial participants were also compared with a sample of general callers to the quitline . Results : The offer of subsidised NRT recruited more than twice as many low-income smokers  than the offer of the cessation service alone ( intervention group n = 1000 ; comparison group n = 377 ) . 63 % were first-time callers to the quitline . Intervention respondents showed higher levels of nicotine dependence than comparison group respondents . Comparisons of quitting data were confounded by the differences in the respondents at baseline . 73.5 % of smokers in the intervention group tried to quit compared to 61.0 % in the comparison group . Unadjusted quit rates were higher in the intervention group than in the comparison group at 3 months and 6 months but not at 12 months . Conclusions : Disadvantaged smokers were easily engaged to call the quitline , particularly when offered subsidised NRT . Disadvantaged smokers using the quitline , with and without subsidised NRT , achieved cessation outcomes comparable to other studies of “ mainstream ” smokers BACKGROUND Smoking is the leading preventable cause of premature death in the United States . Previous studies of financial incentives for smoking cessation in work setting s have not shown that such incentives have significant effects on cessation rates , but these studies have had limited power , and the incentives used may have been insufficient . METHODS We r and omly assigned 878 employees of a multinational company based in the United States to receive information about smoking-cessation programs ( 442 employees ) or to receive information about programs plus financial incentives ( 436 employees ) . The financial incentives were $ 100 for completion of a smoking-cessation program , $ 250 for cessation of smoking within 6 months after study enrollment , as confirmed by a biochemical test , and $ 400 for abstinence for an additional 6 months after the initial cessation , as confirmed by a biochemical test . Individual participants were stratified according to work site , heavy or nonheavy smoking , and income . The primary end point was smoking cessation 9 or 12 months after enrollment , depending on whether initial cessation was reported at 3 or 6 months . Secondary end points were smoking cessation within the first 6 months after enrollment and rates of participation in and completion of smoking-cessation programs . RESULTS The incentive group had significantly higher rates of smoking cessation than did the information-only group 9 or 12 months after enrollment ( 14.7 % vs. 5.0 % , P<0.001 ) and 15 or 18 months after enrollment ( 9.4 % vs. 3.6 % , P<0.001 ) . Incentive-group participants also had significantly higher rates of enrollment in a smoking-cessation program ( 15.4 % vs. 5.4 % , P<0.001 ) , completion of a smoking-cessation program ( 10.8 % vs. 2.5 % , P<0.001 ) , and smoking cessation within the first 6 months after enrollment ( 20.9 % vs. 11.8 % , P<0.001 ) . CONCLUSIONS In this study of employees of one large company , financial incentives for smoking cessation significantly increased the rates of smoking cessation . ( Clinical Trials.gov number , NCT00128375 . Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT Statement , added 1 item , and developed a modified flow diagram . To allow adequate underst and ing and implementation of the CONSORT extension , the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting . This extension , in conjunction with the main CONSORT Statement and other CONSORT extensions , should help to improve the reporting of RCTs performed in this field OBJECTIVE This paper describes the design and findings of a pilot Mothers In Motion ( P-MIM ) program . DESIGN A r and omized controlled trial that collected data via telephone interviews and finger stick at 3 time points : baseline and 2 and 8 months post-intervention . SETTING Three Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) sites in southern Michigan . PARTICIPANTS One hundred and twenty nine overweight and obese African-American and white mothers , 18 - 34 years old . INTERVENTION The 10-week , theory-based , culturally sensitive intervention messages were delivered via a series of 5 chapters on a DVD and complemented by 5 peer support group teleconferences . MAIN OUTCOME MEASURES Dietary fat , fruit , and vegetable intake ; physical activity ; stress ; feelings ; body weight ; and blood glucose . ANALYSIS General linear mixed model was applied to assess treatment effects across 2 and 8 months post-intervention . RESULTS No significant effect sizes were found in primary and secondary outcome variables at 2 and 8 months post-intervention . However , changes in body weight and blood glucose showed apparent trends consistent with the study 's hypotheses . CONCLUSIONS AND IMPLICATION S The P-MIM showed promise for preventing weight gain in low-income overweight and obese women . However , a larger experimental trial is warranted to determine the effectiveness of this intervention One of the key goals of health promotion strategies in the UK and other developed countries is to reduce the prevalence of cigarette consumption . While overall smoking rates in the UK have fallen over the last few decades , they have barely fallen for the least advantaged adults ( Department of Health , 1998a ) . There is a need for interventions that are suitable for lower socio-economic status ( SES ) smokers that have undergone rigorous evaluation . This study describes a r and omized controlled trial of cognitive behaviour therapy ( CBT ) with smokers from a deprived area of London . At 6 months follow-up , 21 ( 17.2 % ) of 122 participants receiving therapy were abstinent and 14 ( 11.5 % ) had reduced cigarette consumption by at least 25 % of pre-treatment level . Six ( 5.6 % ) of 107 participants in the control group were abstinent and none had reduced consumption . These results suggest that this self-help CBT intervention has the potential to reduce the prevalence of smoking among lower SES smokers Background Recruitment and retention are key functions for programs promoting nutrition and other lifestyle behavioral changes in low-income population s. This paper describes strategies for recruitment and retention and presents predictors of early ( two-month post intervention ) and late ( eight-month post intervention ) dropout ( non retention ) and overall retention among young , low-income overweight and obese mothers participating in a community-based r and omized pilot trial called Mothers In Motion . Methods Low-income overweight and obese African American and white mothers ages 18 to 34 were recruited from the Special Supplemental Nutrition Program for Women , Infants , and Children in southern Michigan . Participants ( n = 129 ) were r and omly assigned to an intervention ( n = 64 ) or control ( n = 65 ) group according to a stratification procedure to equalize representation in two racial groups ( African American and white ) and three body mass index categories ( 25.0 - 29.9 kg/m2 , 30.0 - 34.9 kg/m2 , and 35.0 - 39.9 kg/m2 ) . The 10-week theory-based culturally sensitive intervention focused on healthy eating , physical activity , and stress management messages that were delivered via an interactive DVD and reinforced by five peer-support group teleconferences . Forward stepwise multiple logistic regression was performed to examine whether dietary fat , fruit and vegetable intake behaviors , physical activity , perceived stress , positive and negative affect , depression , and race predicted dropout as data were collected two-month and eight-month after the active intervention phase . Results Trained personnel were successful in recruiting subjects . Increased level of depression was a predictor of early dropout ( odds ratio = 1.04 ; 95 % CI = 1.00 , 1.08 ; p = 0.03 ) . Greater stress predicted late dropout ( odds ratio = 0.20 ; 95 % CI = 0.00 , 0.37 ; p = 0.01 ) . Dietary fat , fruit , and vegetable intake behaviors , physical activity , positive and negative affect , and race were not associated with either early or late dropout . Less negative affect was a marginal predictor of participant retention ( odds ratio = 0.57 ; 95 % CI = 0.31 , 1.03 ; p = 0.06 ) . Conclusion Dropout rates in this study were higher for participants who reported higher levels of depression and stress . Trial registration Current Controlled Trials BACKGROUND In the U.S. , Latinos report particularly high levels of inactivity and related chronic illnesses and are in need of intervention . Thus , the purpose of the current study was to culturally and linguistically adapt an empirically supported , individually tailored physical activity print intervention for Latinos and then conduct an RCT of the modified program . DESIGN An RCT was conducted . SETTING / PARTICIPANTS The sample included 93 overweight/obese ( 80 % ) Latinas with low income and acculturation . INTERVENTION Data were collected in 2007 - 2008 and analyzed by intent-to-treat in 2009 . Participants were r and omly assigned to either ( 1 ) a culturally and linguistically adapted physical activity intervention ( Seamos Activas ) or ( 2 ) a wellness contact control condition . MAIN OUTCOME MEASURES Self-report physical activity , as measured pre- and post-intervention ( 6 months , 87 % retention ) by the 7-Day Physical Activity Recall . RESULTS Moderate-intensity ( or greater ) physical activity increased from an average of 16.56 minutes/week ( SD=25.76 ) at baseline to 147.27 ( SD=241.55 ) at 6 months in the intervention arm ( n=45 ) , and from 11.88 minutes/week ( SD=21.99 ) to 96.79 ( SD=118.49 ) in the wellness contact control arm ( n=48 ) . No between-group differences were seen in overall physical activity . Intervention participants reported significantly greater increases in cognitive ( F[1 , 91]=9.53 , p=0.003 ) and behavioral processes of change ( F[1 , 91]=8.37 , p=0.005 ) and available physical activity supplies and equipment at home ( F[1 , 91]=4.17 , p=0.04 ) than control participants . CONCLUSIONS Results supported the hypothesized feasibility , acceptability , and preliminary efficacy of individually tailored physical activity print interventions  among Latinas . Although more research is needed to corroborate these findings , such high-reach , low-cost approaches have great potential to positively affect public health . TRIAL REGISTRATION NCT00724165 Purpose . To determine the efficacy of community-based , culturally tailored exercise intervention on the moderate and vigorous physical activity and physiologic outcomes of low-income Latino women ( Latinas ) . Design . A r and omized trial contrasted safety education to an aerobic dance intervention . Setting . Interventions were held in a “ store-front ” exercise site near a community clinic . Subjects . Sedentary low-income Latinas ( N = 151 ; 18—55 years ; 70 % overweight/obese ) were recruited .  Retention was 91 % for follow-up measures . Intervention . Three sessions per week of supervised aerobic dance were provided for 6 months . Controls attended 18 safety education sessions over 6 months . Measures . Physical activity and aerobic fitness ( VO2max ) were primary outcomes . Results . Participants in the exercise group reported more vigorous exercise ( p < .001 ) and walking ( p = .005 ) at post-test than controls . Aerobic dance and unsupervised activity result ed in a five-fold greater increase in relative VO2max compared with controls ( p < .001 ) . Although exercise and fitness decreased at follow-up , vigorous exercise ( p = .001 ) and relative VO2max ( p < .001 ) remained higher in the exercise group , suggesting maintenance at 1 year . Conclusion . Culturally tailored aerobic dance can increase vigorous physical activity , possibly generalizing to walking , and the combination can improve cardiorespiratory fitness in low-income , overweight , sedentary Latinas Objectives We tested the effect of nurse-delivered telephone individualized social support ( “ Baby BEEP ” ) and eight mailed prenatal smoking cessation booklets singly and in combination ( 2 × 2 factorial design ) on smoking cessation in low-income rural pregnant women ( N = 695 ; 75 % participation ) . Methods Participants r and omized to Baby BEEP groups ( n = 345 ) received weekly calls throughout pregnancy plus 24 - 7 beeper access .  Saliva cotinine sample s were collected monthly from all groups by other nurses at home visits up to 6 weeks post-delivery . Primary outcomes were point prevalence abstinence ( cotinine < 30 ng/ml ) in late pregnancy and post-delivery . Results Only 47 women were lost to follow-up . Intent-to-treat analyses showed no difference across intervention groups ( 17–22 % , late pregnancy ; 11–13.5 % , postpartum ) , and no difference from the controls ( 17 % , late pregnancy ; 13 % , postpartum ) . Post hoc analyses of study completers suggested a four percentage-point advantage for the intervention groups over controls in producing early and mid-pregnancy continuous abstainers .  Partner smoking had no effect on late pregnancy abstinence ( OR = 1.7 , 95 % CI = 0.95 , 3.2 ) , but post-delivery , the effect was pronounced ( OR = 3.2 , 95 % CI = 1.8 , 5.9 ) . Conclusions High abstinence rates in the controls indicate the power of biologic monitoring and home visits to assess stress , support , depression , and intimate partner violence ; these elements plus booklets were as effective as more intensive interventions . Targeting partners who smoke is needed Objective To investigate the relations between causes of death , social position , and obesity in women who had never smoked . Design Prospect i ve cohort study . Setting Renfrew and Paisley , Scotl and . Participants 8353 women and 7049 men aged 45 - 64 were recruited to the Renfrew and Paisley Study in 1972 - 6 . Of these , 3613 women had never smoked and were the focus of this study . They were categorised by occupational class ( I and II , III non-manual , III manual , and IV and V ) and body mass index groups ( normal weight , overweight , moderately obese , and severely obese ) . Main outcome measures All cause and cause specific mortality during 28 years of follow-up by occupational class and body mass index , using Cox proportional hazards models adjusted for age and other confounders . Results The women in lower occupational classes who had never smoked were on average shorter and had poorer lung function and higher systolic blood pressure than women in the higher occupational classes . Overall , 43 % ( n=1555 ) were overweight , 14 % ( n=515 ) moderately obese , and 5 % ( n=194 ) severely obese . Obesity rates were higher in lower occupational classes and much higher in all occupational classes than in current smokers in the full cohort . Half the women died , 51 % ( n=916 ) from cardiovascular disease and 27 % ( n=487 ) from cancer . Relative to occupational class I and II , all cause mortality rates were more than a third higher in occupational classes III manual ( relative rate 1.35 , 95 % confidence interval 1.16 to 1.57 ) and IV and V ( 1.34 , 1.17 to 1.55 ) and largely explained by differences in obesity , systolic blood pressure , and lung function . Similar upward gradients were seen for cardiovascular disease and respiratory disease but not for cancer . Mortality rates were highest in severely obese women in the lowest occupational classes . Conclusions Women who had never smoked and were not obese had the lowest mortality rates , regardless of their social position . Where obesity is socially patterned as in this cohort , it may contribute to health inequalities and increase pressure on health and social services serving more disadvantaged population Purpose . Assess effectiveness of an intervention to improve fruit and vegetable consumption in economically disadvantaged young adults . Design . R and omized treatment-control , pre-post design . Setting . Ten states . Subjects . Young adults ( n = 2024 , ages 18–24 ) were recruited from noncollege venues ; 1255 ( 62 % ) completed assessment interviews at baseline and at 4 and 12 months . Intervention . Treatment participants received a series of mailed material s and two educational calls in 6 months . Controls received a mailed pamphlet . Measures . Assessment calls determined two measures of fruit and vegetable intakes , demographics and stage of change at baseline , 4 and 12 months , plus treatment participants ' decisional balance , processes , and self-efficacy . Analysis . Repeated measure analysis of variance , intent-to-treat , χ2 , and logistic regression . Results . At follow-up , participants in the experimental group had higher intakes of fruit and vegetables than controls ( perceived daily intakes of 4.90 vs. 4.60 servings per day , F = 3.49 , p < .05 and 4.31 vs. 3.92 servings/day via 5-A-Day Screener , F = 4.78 , p < .01 ) and greater progression to action or maintenance stages ( 66 % progress in fruit for intervention vs. 55 % progress in fruit for controls ; 47 % vs. 32 % progress for vegetables , p = .0080 and .0001 , respectively ) . Lower education , non-White ethnicity , male gender , living with children , and experimental group assignment predicted attrition ( X26df = 288 , p < .001 , Cox R2 = .132 ) . Conclusions . Tailored educational messages and research -extension partnerships are advantageous for improving fruit and vegetable intakes of young adults OBJECTIVES We evaluated a theory-based lifestyle intervention targeting physical activity and dietary fat intake among African American women at high risk for cardiovascular disease . METHODS The Heart Healthy and Ethnically Relevant Lifestyle trial ( 2005 - 2008 ) r and omly assigned 266 low-income African American women aged 35 years and older who were patients of South Carolina community health care centers into comprehensive or st and ard care interventions . Comprehensive participants received st and ard care ( stage-matched provider counseling and assisted goal setting ) plus 12 months of telephone counseling and tailored newsletters . Primary outcomes were 6- and 12-month self-reported physical activity and dietary fat intake . RESULTS Comprehensive participants were more likely than were st and ard care participants to decrease total physical activity ( odds ratio [ OR ] = 3.13 ; 95 % confidence interval [ CI ] = 1.18 , 8.25 ) and increase leisure-time physical activity ( OR = 3.82 ; 95 % CI = 1.41 , 10.3 ) at 6 months ( no 12-month differences ) . Mean reductions in Dietary Risk Assessment score occurred in both groups but were greater among comprehensive participants than among st and ard care participants ( 6 months , -8.50 vs -5.34 ; 12 months , -7.16 vs -3.37 ; P < .001 ) . CONCLUSIONS The comprehensive intervention improved women 's leisure-time physical activity and dietary fat intake , highlighting a replicable model to help primary care providers implement lifestyle counseling BACKGROUND Few studies compare the influence of different types of dietary interventions on the dietary practice s of Latinas in the short and long term . The present study examined the 1-year impact of two innovative behavior-change approaches to reduce dietary fat and increase fiber . DESIGN Three-group r and omized controlled trial : ( 1 ) personalized dietary counseling via lay heath advisors ( promotoras ) plus tailored print material s delivered via the mail , ( 2 ) tailored mailed print material s only , and ( 3 ) targeted mailed " off-the-shelf " material s. SETTING / PARTICIPANTS A total of 357 Latinas were r and omly assigned to the three aforementioned conditions . INTERVENTION Promotora and tailored print material s. MAIN OUTCOME MEASURES Fat intake ( total grams of fat and percent calories from dietary fat ) and number of grams of dietary fiber . RESULTS Earlier work reported that at immediate post-intervention the promotora group achieved significantly lower levels of total fat grams , and lower levels of energy intake , total saturated fat , total carbohydrates , glucose , and fructose than the targeted group . However , the present longitudinal analyses suggest that the effects achieved by the promotoras dissipated over the 12-month follow-up period while the effects of the tailored group concurrently improved . CONCLUSIONS The high interactivity ( i.e. , calls , visits ) of the promotora condition may have been the most salient reinforcer and may have led to further tailoring , making this type of intervention more effective than the comparison groups in the short term . Further research should explore whether booster sessions involving promotoras help to maintain the impact over time OBJECTIVES We analyzed outcomes from a study that examined social- context ual factors in cancer prevention interventions for working class , multiethnic population s. METHODS Ten community health centers were r and omized to intervention or to control .  Patients who resided in low-income , multiethnic neighborhoods were eligible ; the intervention targeted fruit and vegetable consumption , red meat consumption , multivitamin intake , and physical activity . Outcomes were measured at 8 months . RESULTS The intervention led to significant increases in fruit and vegetable consumption and multivitamin intake and reductions in red meat consumption ; no change was found in physical activity levels . The intervention effect was not changed when context ual variables that may function as confounders or effect modifiers ( e.g. , gender , education , race/ethnicity , respondent and parents ' country of birth , and poverty status ) were included in the analyses . CONCLUSIONS The intervention led to significant improvements in health behaviors among a working class , multiethnic population , regardless of race/ ethnicity and socioeconomic status . Interventions that respond to the social context of working class individuals across racial/ethnic categories hold promise for improving cancer-related risk behaviors OBJECTIVES Examine the effectiveness of an intervention to increase  fruits and vegetables ( FV ) consumption  among smokers . DESIGN Cluster-r and omized trial of 20 public housing developments ; 10 r and omly assigned to an  FV intervention and 10 to a smoking cessation intervention .  MAIN OUTCOME MEASURES Usual ( past 7 days ) and past 30 days change in daily FV intake at 8 weeks and 6 months postbaseline . RESULTS Greater increases were seen in the FV group . At Week 8 and Month 6 , the FV group had consumed 1.58 ( p = .001 ) and 0.78 ( p = .04 ) , respectively , more daily  FV servings in the past 7 days than the cessation group . At the same time points , the FV group had consumed 3.61 ( p = .01 ) and 3.93 ( p = .01 ) , respectively , more  FV servings in the past 30 days than the cessation group . Completing more motivational interviewing sessions ( p = .02 ) and trying more recipes ( p = .02 ) led to significantly greater increases at Month 6 among FV participants . CONCLUSIONS Motivational interviewing counseling and lifestyle modification through trying out healthy recipes may be effective in helping a high-risk population increase their FV intake BACKGROUND This article describes the process and results of a smoking cessation intervention r and omized clinical trial ( RCT ) that was conducted as a community-based participatory research project . This RCT tested whether outcomes are improved by adding social justice and tobacco industry targeting messages to a smoking cessation program conducted among African American adults within a low-income community in San Francisco , California . This study provides lessons for future similar research projects that focus on urban low-income population s. METHODS Participants were r and omly allocated to receive a smoking-cessation program ( control group [ CG ] ) or CG care plus tobacco industry and media ( IAM ) messages . Primary interventions were behavioral . At intake , participants reporting severe withdrawal or smoking > or = 25 cigarettes daily were offered free nicotine replacement therapy . Baseline data were from an in-person interview . Outcome measures included self-reported smoking status ; validation of quitting was by salivary cotinine assays . RESULTS Of 87 participants providing baseline data , 31 % ( 27 ) did not join the RCT .  Proportions quitting in the CG and IAM group were 11.5 % and 13.6 % at 6 months and 5.3 % and 15.8 % at 12 months , respectively . CONCLUSION African Americans in underserved inner-city neighborhoods can be recruited into RCTs with community participatory approaches . Differences between the CG and IAM in proportions who quit were 2.1 % and 10.5 % at 6 and 12 months , respectively . More than 3 years with adequate funding , high staffing ratios , and intense outreach and follow-up schedules are needed to achieve recruitment and study goals Volitional help sheets use Gollwitzer 's ( 1993 ) concept of implementation intentions as a vehicle to change behaviour using Prochaska and DiClemente 's ( 1983 ) processes of change . The present study design ed and tested a volitional help sheet to increase physical activity in a group with low socioeconomic status ( low-SES ) . Sixty-eight people ( 33 women , 35 men ; mean age 27 ) with low-SES were r and omly allocated to either an experimental group or a control group . Both groups received a question naire and a volitional help sheet ; the only difference between the experimental and control groups was that the former were given explicit instructions to link occasions on which they were tempted not to be physically active with appropriate behavioural responses ( processes of change ) . Physical activity ( Metabolic Equivalent minutes per week ) was the main outcome measure ; behavioural intention and self-efficacy were the secondary outcome measures . The findings revealed significant increase in physical activity in the experimental condition , relative to the control condition , F ( 1 , 66 ) = 7.28 , p < 0.01 , = 0.10 , but no differences for social cognitive variables . Furthermore , the participants who were most responsive to the intervention engaged in more than three times the physical activity at baseline than those who received the intervention but did not subsequently change . The findings provide further support for volitional help sheets to change health behaviour and extend them to a group with low-SES . Further work is required to refine this intervention tool OBJECTIVES We sought to compare the effectiveness of a dental practitioner advice and brief counseling intervention to quit tobacco use versus usual care for patients in community health centers on tobacco cessation ,  reduction in tobacco use , number of quit attempts , and change in readiness to quit . METHODS We r and omized 14 federally funded community health center dental clinics that serve diverse racial/ethnic groups in 3 states ( Mississippi , New York , and Oregon ) to the intervention ( brief advice and assistance , including nicotine replacement therapy ) or usual care group .  RESULTS We enrolled 2549 smokers . Participants in the intervention group reported significantly higher abstinence rates at the 7.5-month follow-up , for both point prevalence ( F(1,12 ) = 6.84 ; P < .05 ) and prolonged abstinence ( F(1,12 ) = 14.62 ; P < .01 ) than did those in the usual care group . CONCLUSIONS The results of our study suggest the viability and effectiveness of tobacco cessation services delivered to low-income smokers via their dental health care practitioner in community health centers . Tobacco cessation services delivered in public dental clinics have the potential to improve the health and well-being of millions of Americans BACKGROUND The Well-Integrated Screening and Evaluation for Women Across the Nation ( WISEWOMAN ) project addresses the need for effective cardiovascular disease ( CVD ) prevention among underserved , midlife women . We describe an Enhanced Intervention that addressed environmental and individual factors within the context of a clinic-based intervention . We also present the study design and baseline results of the r and omized trial to evaluate the enhanced intervention . METHODS The multicomponent behavior change intervention addressed many elements of the Chronic Care Model ( CCM ) , including the community re sources and policy element , wherein Enhanced Intervention participants were encouraged to overcome environmental barriers to a healthy lifestyle by using community re sources . Study participants were enrolled at one community health center ; all were low-income , underinsured , midlife ( 40 - 64 years ) women . RESULTS A total of 236 participants were r and omized to receive the Enhanced Intervention or the Minimum Intervention .  At baseline , over three fourths of the participants were overweight or obese . Participants reported a variety of problematic neighborhood characteristics , including a paucity of restaurants with healthy food choices ( 41 % reported as a problem ) ; not enough farmer 's markets or produce st and s ( 50 % ) , not enough affordable exercise places ( 52 % ) , not enough physical activity programs that met women 's needs ( 42 % ) , heavy traffic ( 47 % ) , and speeding drivers ( 53 % ) . Overall , women knew little about affordable exercise venues and nutrition classes . CONCLUSIONS In this clinic-based intervention , we addressed environmental factors related to a healthy lifestyle . Results indicate the need for effective and feasible intervention strategies to address the environments in which individuals are making behavior changes . The effectiveness of the WISEWOMAN Enhanced Intervention will be assessed in a r and omized trial OBJECTIVE To determine if a clinic-based behavioral intervention program for low-income mid-life women that emphasizes use of community re sources will increase moderate intensity physical activity ( PA ) and improve dietary intake . METHODS R and omized trial conducted from May 2003 to December 2004 at one community health center in Wilmington , NC . A total of 236 women , ages 40 - 64 , were r and omized to receive an Enhanced Intervention ( EI ) or Minimal Intervention ( MI ) . The EI consisted of an intensive phase ( 6 months ) including 2 individual counseling sessions , 3 group sessions , and 3 phone calls from a peer counselor followed by a maintenance phase ( 6 months ) including 1 individual counseling session and 7 monthly peer counselor calls . Both phases included efforts to increase participants ' use of community re sources that promote positive lifestyle change . The MI consisted of a one-time mailing of pamphlets on diet and PA . Outcomes , measured at 6 and 12 months , included the comparison of moderate intensity PA between study groups as assessed by accelerometer ( primary outcome ) and question naire , and dietary intake assessed by question naire and serum carotenoids ( 6 months only ) . RESULTS For accelerometer outcomes , follow-up was 75 % at 6 months and 73 % at 12 months . Though moderate intensity PA increased in the EI and decreased in the MI , the difference between groups was not statistically significant ( p=0.45 ; multivariate model , p=0.08 ) ; however , moderate intensity PA assessed by question naire ( 92 % follow-up at 6 months and 75 % at 12 months ) was greater in the EI ( p=0.01 ; multivariate model , p=0.001 ) . For dietary outcomes , follow-up was 90 % for question naire and 92 % for serum carotenoids at 6 months and 74 % for question naire at 12 months . Dietary intake improved more in the EI compared to the MI ( question naire at 6 and 12 months , p<0.001 ; serum carotenoid index , p=0.05 ; multivariate model , p=0.03 ) . CONCLUSION The EI did not improve objective ly measured PA , but was associated with improved self-reported and objective measures of dietary intake INTRODUCTION Tobacco use is a serious public health problem among low-income Chinese Americans with limited English proficiency . Chinese men are at high risk for smoking-related morbidity and mortality . We tested the feasibility of a culturally and linguistically sensitive smoking intervention program with combined counseling and pharmacological components for Chinese smokers in New York City ; identified factors and techniques that enhance the administration and appropriateness of the intervention program ; and examined the overall impact of this program on quit attempts , quit rates , and overall smoking reduction . METHODS We were guided by the transtheoretical model and used an adapted motivational interviewing ( MI ) approach . The study involved a r and omized sample with pretreatment assessment and multiple follow-up measures . Eligible participants ( N = 122 ) were r and omly assigned to intervention ( 4 individualized counselor-led MI sessions and nicotine replacement therapy [ NRT ] ) or control groups ( 4 general health education sessions , self-help material s , and NRT ) . RESULTS Quit rate at 6 months in the intervention group was 67 % versus 32 % for the control group , indicating minimal relapse and a highly successful intervention program . Increase in self-efficacy and decease in pros of smoking from baseline to 6-month follow-up were positively associated with smoking cessation . The number of cigarette smoked at baseline was inversely related to smoking cessation . Results indicate that a combined intensive behavioral counseling and pharmacological intervention can reduce smoking substantially . CONCLUSION The results of this pilot will be used as a basis for a large-scale r and omized trial of an intervention with combined culturally and linguistically sensitive MI and NRT components for Chinese and other Asian ethnic groups OBJECTIVES To evaluate Cookin ' Up Health , a computer-based interactive nutrition intervention . METHODS After r and omization to intervention and control groups , 262 women in rural clinics in West Virginia completed both a baseline and 3-month follow-up survey . RESULTS Compared to the control group , the intervention group had significantly improved scores on knowledge of dietary fats , food label reading , and readiness to eat 5 fruits and vegetables a day and foods lower in fat . CONCLUSIONS This brief interactive nutrition intervention shows potential as a strategy to begin the process of change , but follow-up may be needed for actual behavior change to occur INTRODUCTION Postpartum relapse rates are high among women who spontaneously quit smoking during pregnancy . This r and omized clinical trial tested a Motivation and Problem-Solving ( MAPS ) treatment for reducing postpartum relapse among diverse low-income women who quit smoking during pregnancy ( N = 251 ; 32 % Black , 30 % Latino , and 36 % White ; 55 % < $ 30,000/year household income ) . METHODS Pregnant women were r and omly assigned to MAPS/MAPS+ or Usual Care ( UC ) . Continuation ratio logit models were used to examine differences in biochemically confirmed continuous abstinence at Weeks 8 and 26 postpartum by treatment group and moderators of the treatment effect . Analyses controlled for age , race/ethnicity , partner status , education , smoking rate , and the number of smokers in the participant 's environment . RESULTS MAPS/MAPS+ was more efficacious than UC in the prevention of postpartum relapse ( p = .05 ) . An interaction between treatment and the number of cigarettes smoked per day before quitting approached significance ( p = .09 ) , suggesting that the MAPS/MAPS+ treatment effect was stronger among women who smoked more cigarettes per day . DISCUSSION MAPS , a holistic and dynamic approach to changing behavior using a combined motivational enhancement and social cognitive approach , is a promising intervention for postpartum smoking relapse prevention among low-income women , which may have particular relevance for women with higher prequit smoking rates Despite high smoking rates among those living in poverty , few cessation studies are conducted in these population s. This cluster-r and omized trial tested nicotine gum plus motivational interviewing ( MI ) for smoking cessation in 20 low-income housing developments ( HDs ) . Intervention participants ( 10 HDs , n = 66 ) received educational material s , 8 weeks of 4 mg nicotine gum , and 5 MI sessions on quitting smoking . Comparison participants ( 10 HDs , n = 107 ) received 5 MI sessions and educational material s addressing fruit and vegetable consumption . Participants had a mean age of 46.3 years and were predominantly female ( 70 % ) and African American ( 83 % ) .  Biochemically-verified 7-day abstinence rates at 8 weeks were 6.1 % and 5.6 % in the intervention and comparison arms , respectively ( p = ns ) ; and at 26 weeks were 7.6 % and 9.3 % , respectively ( p = ns ) . Results suggest that nicotine gum plus MI were not effective for smoking cessation in low-income housing . Programs are needed to enhance the effectiveness of pharmacotherapy and counseling in underserved population INTRODUCTION This study explored predictors of smoking quit attempts in a sample of low-income smoking mothers who participated in a r and omized trial of a 6-month , 14-session counseling intervention to decrease their children 's secondh and smoke exposure ( SHSe ) and eliminate smoking . METHODS Measures were taken at baseline and at 3 , 6 , 12 , and 18 months on 150 mothers who exposed their children ( aged < 4 years ) to > or = 10 cigarettes/week in the home . Reported 7-day quits were verified by saliva cotinine or urine anabasine and anatabine levels . RESULTS There were few quits longer than 6 months . Mothers in the counseling group reported more 24-hr quits ( p = .019 ) and more 7-day quits ( p = .029 ) than controls . Multivariate modeling revealed that having quit for at least 24 hr in the year prior to baseline and the number of alternative cessation methods ever tried were predictive of the longest quit attempt during the 18-month study . Mothers in the counseling group who at baseline felt SHSe posed a health risk for their children or who at baseline had more permissive home smoking policies had longer quit attempts . DISCUSSION Results confirm that attempts to quit smoking predict additional quit attempts . This suggests that practice may be necessary for many people to quit smoking permanently . Findings of interaction analyses suggest that participant factors may alter the effects of treatment procedures . Failure to account for or employ such factors in the analysis or design of community trials could confound the results of intervention trials BACKGROUND Latinas in the U.S. are less physically active than non-Latino white women and also report higher levels of diabetes , obesity , and other conditions related to inactivity . Interventions are needed to address disparities in this high-risk group . PURPOSE To evaluate the efficacy of a culturally adapted , Spanish- language , individually tailored , computer expert system-driven physical activity print-based intervention for adult Latinas . DESIGN RCT . SETTING / PARTICIPANTS Participants were 266 inactive adult Latinas who participated between 2009 and 2012 . INTERVENTION Participants were r and omized to one of two treatment arms : a 6-month tailored physical activity intervention condition or wellness contact control . For both conditions , print material s were delivered by mail . MAIN OUTCOME MEASURES The main outcome measure was change in weekly moderate-to-vigorous physical activity ( MVPA ) measured by the 7-Day Physical Activity Recall interview , which was administered at baseline and post-intervention ( 6 months ) . Participants also wore accelerometers for a week at baseline and follow-up . Analyses were conducted in 2013 . RESULTS Increases in minutes/week of MVPA measured by the 7-Day PAR were significantly greater in the intervention group compared to the control group ( mean difference=41.36 , SE=7.93 , p<0.01 ) . This difference was corroborated by accelerometer readings ( rho=0.44 , p<0.01 ) . Further , results indicate that intervention participants had greater increases in self-efficacy , cognitive processes , and behavioral processes at 3 months compared to control paricipants ( p's<0.05 ) . CONCLUSIONS The tailored Spanish- language intervention was effective in increasing MVPA among predominantly low-income , less-acculturated Latinas . Such print-based interventions are poised for widespread dissemination , and thus may help address health disparities AIMS To assess the effects of adding motivational interviewing ( MI ) counseling to nicotine patch for smoking cessation among homeless smokers . DESIGN Two-group r and omized controlled trial with 26-week follow-up . PARTICIPANTS AND SETTING A total of 430 homeless smokers from emergency shelters and transitional housing units in Minneapolis/St Paul , Minnesota , USA . INTERVENTION AND MEASUREMENTS All participants received 8-week treatment of 21-mg nicotine patch . In addition , participants in the intervention group received six individual sessions of MI counseling which aim ed to increase adherence to nicotine patches and to motivate cessation . Participants in the st and ard care control group received one session of brief advice to quit smoking . Primary outcome was 7-day abstinence from cigarette smoking at 26 weeks , as vali date d by exhaled carbon monoxide and salivary cotinine . FINDINGS Using intention-to-treat analysis , verified 7-day abstinence rate at week 26 for the intervention group was non-significantly higher than for the control group ( 9.3 % versus 5.6 % , P = 0.15 ) . Among participants who did not quit smoking , reduction in number of cigarettes from baseline to week 26 was equally high in both study groups ( -13.7 ± 11.9 for MI versus -13.5 ± 16.2 for st and ard care ) . CONCLUSIONS Adding motivational interviewing counseling to nicotine patch did not increase smoking rate significantly at 26-week follow-up for homeless smokers
Objective To conduct a systematic review and meta- analysis examining the effectiveness of behavioural interventions targeting diet , physical activity or smoking in low-income adults .