***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study examined the direct and mediated impact of a self-administered , computer-based intervention on nutrition behavior , self-efficacy , and outcome expectations among supermarket food shoppers . The intervention , housed in kiosks in supermarkets and based on social cognitive theory , used tailored information and self-regulation strategies delivered in 15 brief weekly segments . The study sample ( N = 277 ) , stratified and r and omly assigned to treatment or control , was 96 % female , was 92 % White , had a median annual income of about $ 35,000 , and had a mean education of 14.78 ±2.11 years . About 12 % of the sample reported incomes of $ 20,000 or less , and about 20 % reported 12 years or fewer of education . Analysis of covariance immediately after intervention and at a 4- to 6-month follow-up found that treatment led to improved levels of fat , fiber , and fruits and vegetables . Treatment also led to higher levels of nutrition-related self-efficacy , physical outcome expectations , and social outcome expectations . Logistic regression analysis determined that the treatment group was more likely than the control group to attain goals for fat , fiber , and fruits and vegetables at posttest and to attain goals for fat at follow-up . Latent variable structural equation analysis revealed self-efficacy and physical outcome expectations mediated treatment effects on nutrition . In addition , physical outcome expectations mediated the effect of self-efficacy on nutrition outcomes . Implication s for future computer-based health promotion interventions are discussed Background Obesity among Black women continues to exceed that of other women . Most weight loss programs created without reference to specific cultural context s are less effective for Black than White women . Weight control approaches accessible to Black women and adapted to relevant cultural context s are important for addressing this problem . This paper reports the final results of SisterTalk , the r and omized controlled trial of a cable TV weight control program oriented toward Black women . Methods A five group design included a comparison group and a 2 × 2 factorial comparison of a ) interactive vs. passive programming and b ) telephone social support vs no telephone support , with 12 weekly initial cable TV programs followed by 4 monthly booster videos . At baseline , 3 , 8 , and 12 months post r and omization , telephone and in person surveys were administered on diet , physical activity , and physical measurements of height and weight were taken to calculate body mass index ( BMI ) . Analysis of variance ( ANOVA ) was used to examine differences over time , and between treatment and comparison groups . Dose variables reflecting use of the TV/video and written material s were also assessed . Results At 3 months , BMI , weight , and dietary fat were significantly lower and physical activity significantly higher among women exposed to the Cable TV intervention compared to the wait-list comparison group . Significant dietary fat differences were still observed at 8 and 12 month evaluations , but not BMI or physical activity differences . Main effects were not observed for interactive programming or enhanced social support at any time point . Within the intervention group , higher watching of the TV series and higher reading of educational material s were both ( separately ) associated with significantly lower dietary fat . Conclusions Cable TV was an effective delivery channel to assist Black women with weight control , increasing physical activity and decreasing dietary fat during an initial intervention period , but only dietary changes persisted Enhanced social support and the ability to interact with others during the show were not effective complementary intervention components as conducted in this trial . Future research to strengthen the ability of this approach to achieve long term effects may offer even more promising outcomes Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To examine the relative cost-effectiveness of a self-administered video series in delivering nutrition education to low-income homemakers . DESIGN A quasi-experimental design was used , with subjects r and omly assigned to traditional lessons ( Traditional Group ) or video lessons ( Video Group ) . SUBJECTS/ SETTING 108 subjects were recruited , with 93 nonpregnant , low-income , female homemakers completing the study ( response rate = 86 % ) . Subjects had recently enrolled in the Exp and ed Food and Nutrition Education Program , or the Food Stamp Nutrition Education Program , and had a videocassette recorder and telephone . INTERVENTION Both groups received 12 lessons from the Eating Right Is Basic Series , 3rd edition , with the Traditional Group being taught in face-to-face sessions and the Video Group receiving self-administered , video-lesson packets . OUTCOME MEASURES Dietary intake and food behaviors were assessed at pre and post intervention with 24-hour recalls and a 14-item checklist . STATISTICAL ANALYSES Chi(2 ) and t tests were used to compare the groups on demographics and pre-intervention dietary factors . Multiple analysis of variance was used for comparisons of change from pre to post intervention . RESULTS Significant improvements were observed in both groups for fruits , calcium , and vitamins A and C. The Video Group improved on fiber intake ( P < or=.005 ) . The groups did not differ on dietary or behavior change ( P=.2357 ) . Duplication and implementation costs of the video series totaled 4,820 dollars , or 36 % of the traditional lesson cost of 13,463 dollars . APPLICATIONS Both methods achieved similar improvements in diet and behaviors , but the video method was less expensive . The video series seems to be a cost-effective method for delivering nutrition education to low-income homemakers Background Effective , low-cost approaches are needed to enhance dietary behavior change . While both video and tailoring technology have been effective interventions to improve diet , these approaches have never been combined to study the effectiveness of tailored videos . The purpose of this paper is to discuss the results of Good For You ! , a r and omized trial that tested the efficacy of innovative , individually tailored videos in helping worksite employees decrease dietary fat and increase fruit and vegetable ( F&V ) intake . Methods Worksites were matched on approximate size , type of company and workforce composition and r and omized to one of three experimental conditions : Non-Tailored written information ( NT ) ( n = 14 ) , Tailored Written information ( TW ) ( n = 14 ) , or Tailored Written + Tailored Video ( TW + TV ) ( n = 15 ) . Evaluation was conducted at baseline , 4 and 7 months . We used the NCI Fat Screener and an adapted Food Habits Question naire ( FHQ ) to estimate fat intake and fat-related behaviors , the NCI F&V Screener and F&V Habits Question naire ( FVHQ ) to measure F&V intake and behaviors . Generalized linear models were examined for all outcome measurements . Results 2525 worksite employees were recruited . At 4 months , dietary fat intake decreased significantly more for TW ( −2.95 % ) and TW + TV ( −3.14 % ) compared with NT ( −2.42 % ) . FHQ scores decreased significantly more for TW + TV than the other two groups . Fruit intake increased the most for TW + TV compared to NT and TW . Both TW ( 1.30 cups ) and TW + TV ( 1.59 cups ) increased F&V intake significantly more than NT ( 0.78 cups ) . TW + TV showed the largest increase in F&V behaviors on the FVFQ . At 8 months , dietary fat change continued to be significantly better for TW + TV ( −3.48 % ) than NT ( 3.01 % ) . F&V intake increased significantly more for the TW + TV group ( 1.38 cups ) compared to the NT group ( 1.04 cups ) and FVHQ changes were significantly greater in TW + TV and TW than for NT . Conclusions The tailored intervention participants were more likely to decrease fat and increase F&V intake . The TW + TV group was generally the stronger of the two tailored interventions , especially at the longer term follow-up , demonstrating the promise of tailored video as an intervention to change eating habits . Future studies should explore newer channels and technologies in addition to DVDs for delivering tailored video interventions such as the internet and smart phones . Trial Registration Clinical Trials.gov identifier : This article describes the development and pilot evaluation of a tailored multimedia program to improve dietary behavior among 378 low-income women enrolled in the Food Stamp program in Durham , North Carolina . After r and omization to intervention or control groups , participants completed a baseline survey and were resurveyed 1 - 3 months post-intervention . Measures included dietary fat intake assessed using a brief food-frequency question naire , stage of change , knowledge of low-fat foods , self-efficacy and eating behavior questions . The computer-based intervention consisted of a tailored soap opera and interactive ' info-mercials ' that provided individualized feedback about  dietary fat intake  , knowledge and strategies for lowering fat based on stage of change . At follow-up , intervention group participants had improved significantly in knowledge ( P < 0.001 ) , stage of change ( P < 0.05 ) and certain eating behaviors ( P < 0.05 ) compared to the control group . Both study groups had lowered their reported fat intake markedly at follow-up ( P < 0.001 ) , but did not differ significantly from each other . A majority of participants rated the program as very helpful and were interested in using a similar program in the future . The findings of this pilot study suggest that computerized tailored self-help health promotion programs may be effective educational interventions for lower income and minority population Background Vitamin D plays a key role in bone health . Consuming adequate vitamin D during young adulthood is important due to the development of peak bone mass ; however , many Canadian young adults do not meet vitamin D recommendations . This study aim ed to improve knowledge , perceptions , dietary intake and blood concentrations of vitamin D among a sample of young adults . Methods Using a pre-post design , 90 Ontario adults ( 38 men , 52 women ; 18–25 years ) , were r and omly assigned to intervention or control groups . Participants completed a socio-demographic survey , pre-post food frequency question naire , and a vitamin D knowledge question naire ( 3 time-points ) . The intervention group watched a video , received online information and tracked intake of vitamin D using a mobile application for 12 weeks . A sub- sample of participants completed pre-post blood 25(OH)D3 tests  . Univariate ANOVA tested pre-post between-group differences in vitamin D intake and status . Repeated- measures ANOVA tested between-group differences in vitamin D knowledge and perceptions across 3 time-points . Results Mean vitamin D intake in the sample increased significantly from pre-test ( M = 407 , SD = 460 IU ) to post-test ( M = 619 , SD = 655 IU ) , t(88 ) = 5.37 , p < 0.001 . Mean intake increased significantly more in the intervention than control group after controlling for gender and education , F(1 , 85 ) = 4.09 , p = 0.046 . Mean blood vitamin D3 was significantly higher among non-Caucasian than Caucasian participants at baseline , t(56.7 ) = 3.49 , p = 0.001 . Mean blood vitamin D3 increased significantly from pre-test ( M = 28 , SD = 16 nmol/L ) to post-test ( M = 43 , SD = 29 nmol/L ) , t(53 ) = 11.36 , p < 0.001 , but did not differ significantly between groups . The increase in vitamin D knowledge from time 1–3 was significantly higher in the intervention than control group ( t(88 ) = 2.26 , p = 0.03 ) . The intervention group ( M = 3.52 , SE = 0.13 ) had higher overall perceived importance of vitamin D supplementation than the control ( M = 3.16 , SE = 0.12 ) , F(1 , 88 ) = 4.38 , p = 0.04 , ηp2 = 0.05 . Conclusions Although recommendations suggest blood 25(OH)D3 concentrations of ≥50 - 75 nmol/L , vitamin D status was below national recommendations . While participating in an intervention did not improve vitamin D status , it led to increased vitamin D intake , knowledge and perceived importance of supplementation . Trial registration Clinical Trails.gov registration # : NCT02118129 OBJECTIVE To develop and evaluate a portion plate for adolescents ( Nutri-plate ) . METHODS Sixteen African American adolescents ( mean age = 12.94 years ; 66 % male ) were r and omized to participate in either plate design or nutrition education sessions .  Adolescents ' input was used to create the Nutri-plate , and participants ' food selection and intake was evaluated . RESULTS Adolescents indicated the plate should include simple yet colorful visual and textual information about healthful eating . Participants left less food on their plate when dining with the Nutri-plate as compared with a plain plate ( P < .01 ) . Examination of effect sizes suggested that when using the Nutri-plate , participants selected less food overall ( d = 0.73 ) , more fruit ( d = -0.64 ) , more broccoli au gratin ( d = -0.85 ) , and less steamed broccoli ( d = 0.87 ) . Participants with higher body mass index selected a greater amount of healthful food when using the Nutri-plate ( P < .05 ) . CONCLUSIONS AND IMPLICATION S Further evaluation is needed to determine the influence of a portion plate on adolescents ' nutritional behaviors 
    Output:
    
Visualized nutrition education was overall promising in improving dietary behaviors .
Delivering in series , short in length , with cultural adaptation were features tended to enlarge the benefits of visualized education while loss-framing and video modeling might be avoided