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Predictors of engagement and outcome achievement in a behavioural intervention targeting sugar-sweetened beverage intake among rural adults

  • Kathleen J Porter (a1), Jessica L Thomson (a2) and Jamie M Zoellner (a1)



To describe relationships among baseline characteristics, engagement indicators and outcomes for rural participants enrolled in SIPsmartER, a behavioural intervention targeting sugar-sweetened beverage (SSB) intake.


A secondary data analysis. Bivariate analyses determined relationships among baseline characteristics (e.g. age, gender, race, education, income), engagement indicators (completion of 6-month health screening, class attendance, call completion) and SSB outcomes (SSB ounce reduction (i.e. US fluid ounces; 1 US fl. oz = 29·57 ml), reduced ≥12 ounces, achieved ≤8 ounce intake). Generalized linear models tested for significant effects of baseline characteristics on engagement indicators and of baseline characteristics and engagement indicators on SSB outcomes.


South-west Virginia, USA, a rural, medically underserved region.


Participants’ (n 155) mean age was 41 years; most were female (81 %), White (91 %) and earned ≤$US 20 000 per annum (61 %).


All final models were significant. Engagement models predicted 12–17 % of variance, with age being a significant predictor in all three models. SSB outcome models explained 5–70 % of variance. Number of classes attended was a significant predictor of SSB ounce reduction (β = −6·12, P < 0·01). Baseline SSB intake significantly predicted SSB ounce reduction (β = −0·90, P < 0·001) and achieved ≤8 ounce intake (β = 0·98, P < 0·05).


The study identifies several participant baseline characteristics that may impact engagement in and outcomes from a community-based intervention targeting SSB intake. Findings suggest greater attendance of SIPsmartER classes is associated with greater reduction in overall SSB intake; yet engagement variables did not predict other outcomes. Findings will inform the future implementation of SIPsmartER and research studies of similar design and intent.


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Data collected while with the Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA.



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1. Leung, AWY, Chan, RSM, Sea, MMM et al. (2017) An overview of factors associated with adherence to lifestyle modification programs for weight management in adults. Int J Environ Res Public Health 14, E922.
2. Nobles, JD, Perez, A, Skelton, JA et al. (2018) The engagement pathway: a conceptual framework of engagement-related terms in weight management. Obes Res Clin Pract 12, 133138.
3. Stoutenberg, M, Stanzilis, K & Falcon, A (2015) Translation of lifestyle modification programs focused on physical activity and dietary habits delivered in community settings. Int J Behav Med 22, 312327.
4. Moroshko, I, Brennan, L & O’Brien, P (2011) Predictors of dropout in weight loss interventions: a systematic review of the literature. Obes Rev 12, 912934.
5. Kaiser, KA, Affuso, O, Desmond, R et al. (2014) Baseline participant characteristics and risk for dropout from ten obesity randomized controlled trials: a pooled analysis of individual level data. Front Nutr 1, 00025.
6. Burgess, E, Hassmen, P & Pumpa, KL (2017) Determinants of adherence to lifestyle intervention in adults with obesity: a systematic review. Clin Obes 7, 123135.
7. Durlak, JA & DuPre, EP (2008) Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol 41, 327350.
8. Thomson, JL, Tussing-Humphreys, LM, Goodman, MH et al. (2015) Engagement indicators predict health changes in a lifestyle intervention. Am J Health Behav 39, 409420.
9. Popkin, BM, Armstrong, LE, Bray, GM et al. (2006) A new proposed guidance system for beverage consumption in the United States. Am J Clin Nutr 83, 529542.
10. Kit, BK, Fakhouri, TH, Park, S et al. (2013) Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999–2010. Am J Clin Nutr 98, 180188.
11. Rosinger, A, Herrick, K, Gahche, J et al. (2017) Sugar-sweetened beverage consumption among US adults, 2011–2014. NCHS Data Brief issue 270, 18.
12. Malik, VS, Popkin, BM, Bray, GA et al. (2010) Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 121, 13561364.
13. Chen, L, Caballero, B, Mitchell, DC et al. (2010) Reducing consumption of sugar-sweetened beverages is associated with reduced blood pressure: a prospective study among United States adults. Circulation 121, 23982406.
14. Vargas-Garcia, EJ, Evans, CEL, Prestwich, A et al. (2017) Interventions to reduce consumption of sugar-sweetened beverages or increase water intake: evidence from a systematic review and meta-analysis. Obes Rev 18, 13501363.
15. Ostbye, T, Krause, KM, Stroo, M et al. (2012) Parent-focused change to prevent obesity in preschoolers: results from the KAN-DO study. Prev Med 55, 188195.
16. Ostbye, T, Zucker, NL, Krause, KM et al. (2011) Kids and adults now! Defeat Obesity (KAN-DO): rationale, design and baseline characteristics. Contemp Clin Trials 32, 461469.10.1016/j.cct.2011.01.017
17. Zoellner, J, Chen, Y, Davy, B et al. (2014) Talking Health, a pragmatic randomized-controlled health literacy trial targeting sugar-sweetened beverage consumption among adults: rationale, design & methods. Contemp Clin Trials 37, 4357.
18. Zoellner, J, Hedrick, V, You, W et al. (2016) Effects of a behavioral and health literacy intervention to reduce sugar-sweetened beverages: a randomized-controlled trial. Int J Behav Nutr Phys Act 13, 38.
19. National Cancer Institute (2018) Research-Tested Intervention Programs (RTIPs). (accessed November 2019).
20. Bailey, AN, , KJ, Hill, JL et al. (2016) The impact of health literacy on rural adults’ satisfaction with a multi-component intervention to reduce sugar-sweetened beverage intake. Health Educ Res 31, 492508.
21. Virginia Department of Health (2013) Virginia’s State Rural Health Plan: Supporting Rural Health Through Community Engagement and Action. (accessed November 2019).
22. Zoellner, J, Krzeski, E, Harden, S et al. (2012) Qualitative application of the theory of planned behavior to understand beverage consumption behaviors among adults. J Acad Nutr Diet 112, 17741784.10.1016/j.jand.2012.06.368
23. Estabrooks, P, You, W, Hedrick, V et al. (2017) A pragmatic examination of active and passive recruitment methods to improve the reach of community lifestyle programs: the Talking Health Trial. Int J Behav Nutr Phys Act 14, 7.10.1186/s12966-017-0462-6
24. Porter, K, Chen, Y, Estabrooks, P et al. (2016) Using teach-back to understand participant behavioral self-monitoring skills across health literacy level and behavioral condition. J Nutr Educ Behav 48, 2026.e1.
25. Fitzpatrick, SL, Jeffery, R, Johnson, KC et al. (2014) Baseline predictors of missed visits in the Look AHEAD study. Obesity (Silver Spring) 22, 131140.
26. Kerby, TJ, Asche, SE, Maciosek, MV et al. (2012) Adherence to blood pressure telemonitoring in a cluster-randomized clinical trial. J Clin Hypertens (Greenwich) 14, 668674.
27. Thomson, JL, Landry, AS, Zoellner, JM et al. (2015) Participant adherence indicators predict changes in blood pressure, anthropometric measures, and self-reported physical activity in a lifestyle intervention: HUB City Steps. Health Educ Behav 42, 8491.
28. Zoellner, JM, Hill, J, You, W et al. (2017) The influence of parental health literacy status on reach, attendance, retention, and outcomes in a family-based childhood obesity treatment program, Virginia, 2013–2015. Prev Chronic Dis 14, E87.
29. Williams, NA, Coday, M, Somes, G et al. (2010) Risk factors for poor attendance in a family-based pediatric obesity intervention program for young children. J Dev Behav Pediatr 31, 705712.10.1097/DBP.0b013e3181f17b1c
30. Weiss, BD, Mays, MZ, Martz, W et al. (2005) Quick assessment of literacy in primary care: the Newest Vital Sign. Ann Fam Med 3, 514522.
31. Hedrick, VE, Savla, J, Comber, DL et al. (2012) Development of a brief questionnaire to assess habitual beverage intake (BEVQ-15): sugar-sweetened beverages and total beverage energy intake. J Acad Nutr Diet 112, 840849.10.1016/j.jand.2012.01.023
32. Riebl, SK, Paone, AC, Hedrick, VE et al. (2013) The comparative validity of interactive multimedia questionnaires to paper-administered questionnaires for beverage intake and physical activity: pilot study. JMIR Res Protoc 2, e40.
33. Neve, MJ, Collins, CE & Morgan, PJ (2010) Dropout, nonusage attrition, and pretreatment predictors of nonusage attrition in a commercial web-based weight loss program. J Med Internet Res   12, e69.
34. Lemstra, M, Bird, Y, Nwankwo, C et al. (2016) Weight loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Prefer Adherence 10, 15471559.
35. Thompson, FE, McNeel, TS, Dowling, EC et al. (2009) Interrelationships of added sugars intake, socioeconomic status, and race/ethnicity in adults in the United States: National Health Interview Survey, 2005. J Am Diet Assoc 109, 13761383.
36. Davy, BM, You, W, Almeida, F et al. (2014) Impact of individual and worksite environmental factors on water and sugar-sweetened beverage consumption among overweight employees. Prev Chronic Dis 11, E71.
37. Han, E & Powell, LM (2013) Consumption patterns of sugar-sweetened beverages in the United States. J Acad Nutr Diet 113, 4353.
38. Zoellner, J, You, W, Connell, C et al. (2011) Health literacy is associated with healthy eating index scores and sugar-sweetened beverage intake: findings from the rural Lower Mississippi Delta. J Am Diet Assoc 111, 10121020.
39. Sharkey, JR, Johnson, CM & Dean, WR (2011) Less-healthy eating behaviors have a greater association with a high level of sugar-sweetened beverage consumption among rural adults than among urban adults. Food Nutr Res 2011, 55.
40. Albanese, AM, Huffman, JC, Celano, CM et al. (2018) The role of spousal support for dietary adherence among type 2 diabetes patients: a narrative review. Soc Work Health Care 58, 3.


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Predictors of engagement and outcome achievement in a behavioural intervention targeting sugar-sweetened beverage intake among rural adults

  • Kathleen J Porter (a1), Jessica L Thomson (a2) and Jamie M Zoellner (a1)


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