Houston TK , Allison JJ , Sussman M , Horn W , Holt CL , Trobaugh J , Salas M , Pisu M , Cuffee YL , Larkin D , Person SD , Barton B , Kiefe CI , Hullett S .

the Center for Healthcare Quality, Outcomes, and Economic Research, eHealth Quality Enhancement Research Initiative, and Bedford Veterans Affairs Medical Center, Bedford, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; Cooper Green Mercy Hospital and University of Alabama at Birmingham, Birmingham, Alabama; University of Maryland, College Park, Maryland; University of Pennsylvania, Philadelphia, Pennsylvania; and AstraZeneca, Wilmington, Delaware.

Abstract

Background: Storytelling is emerging as a powerful tool for health promotion in vulnerable populations. However, these interventions remain largely untested in rigorous studies. Objective: To test an interactive storytelling intervention involving DVDs. Design: Randomized, controlled trial in which comparison patients received an attention control DVD. Separate random assignments were performed for patients with controlled or uncontrolled hypertension. (ClinicalTrials.gov registration number: NCT00875225) Setting: An inner-city safety-net clinic in the southern United States. Patients: 230 African Americans with hypertension. Intervention: 3 DVDs that contained patient stories. Storytellers were drawn from the patient population. Measurements: The outcomes were differential change in blood pressure for patients in the intervention versus the comparison group at baseline, 3 months, and 6 to 9 months. Results: 299 African American patients were randomly assigned between December 2007 and May 2008 and 76.9% were retained throughout the study. Most patients (71.4%) were women, and the mean age was 53.7 years. Baseline mean systolic and diastolic pressures were similar in both groups. Among patients with baseline uncontrolled hypertension, reduction favored the intervention group at 3 months for both systolic (11.21 mm Hg [95% CI, 2.51 to 19.9 mm Hg]; P = 0.012) and diastolic (6.43 mm Hg [CI, 1.49 to 11.45 mm Hg]; P = 0.012) blood pressures. Patients with baseline controlled hypertension did not significantly differ over time between study groups. Blood pressure subsequently increased for both groups, but between-group differences remained relatively constant. Limitation: This was a single-site study with 23% loss to follow-up and only 6 months of follow-up. Conclusion: The storytelling intervention produced substantial and significant improvements in blood pressure for patients with baseline uncontrolled hypertension. Primary Funding Source: Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation.

Vermeer WM , Steenhuis IH , Leeuwis FH , Heymans MW , Seidell JC .

Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.

Background:Environmental interventions directed at portion size might help consumers to reduce their food intake.Objective:To assess whether offering a smaller hot meal, in addition to the existing size, stimulates people to replace their large meal with a smaller meal.Design:Longitudinal randomized controlled trial assessing the impact of introducing small portion sizes and pricing strategies on consumer choices.Setting/participants:In all, 25 worksite cafeterias and a panel consisting of 308 consumers (mean age=39.18 years, 50% women).Intervention:A small portion size of hot meals was offered in addition to the existing size. The meals were either proportionally priced (that is, the price per gram was comparable regardless of the size) or value size pricing was employed.Main outcome measures:Daily sales of small and the total number of meals, consumers’ self-reported compensation behavior and frequency of purchasing small meals.Results:The ratio of small meals sales in relation to large meals sales was 10.2%. No effect of proportional pricing was found B=-0.11 (0.33), P=0.74, confidence interval (CI): -0.76 to 0.54). The consumer data indicated that 19.5% of the participants who had selected a small meal often-to-always purchased more products than usual in the worksite cafeteria. Small meal purchases were negatively related to being male (B=-0.85 (0.20), P=0.00, CI: -1.24 to -0.46, n=178).Conclusion:When offering a small meal in addition to the existing size, a percentage of consumers that is considered reasonable were inclined to replace the large meal with the small meal. Proportional prices did not have an additional effect. The possible occurrence of compensation behavior is an issue that merits further attention.

International Journal of Obesity advance online publication, 11 January 2011; doi:10.1038/ijo.2010.271.