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A Multicomponent Program for Nutrition and Physical Activity Change in Primary Care
PACE+ for Adolescents
Kevin Patrick, MD, MS;
James F. Sallis, PhD;
Judith J. Prochaska, MS;
David D. Lydston, MS;
Karen J. Calfas, PhD;
Marion F. Zabinski, BA;
Denise E. Wilfley, PhD;
Brian E. Saelens, PhD;
David R. Brown, PhD
Arch Pediatr Adolesc Med. 2001;155:940-946.
Background Most adolescents do not meet national recommendations for nutrition
and physical activity. However, no studies of physical activity and nutrition
interventions for adolescents conducted in health care settings have been
published. The present study was an initial evaluation of the PACE+ (Patient-centered
Assessment and Counseling for Exercise plus Nutrition) program, delivered
in primary care settings.
Participants Adolescents aged 11 to 18 years (N = 117) were recruited from 4 pediatric
and adolescent medicine outpatient clinics. Participants' mean (SD) age was
14.1 (2.0) years, 37% were girls, and 43% were ethnic minorities.
Intervention Behavioral targets were moderate physical activity, vigorous physical
activity, fat intake, and fruit and vegetable intake. All patients completed
a computerized assessment, created tailored action plans to change behavior,
and discussed the plans with their health care provider. Patients were then
randomly assigned to receive no further contact or 1 of 3 extended interventions:
mail only, infrequent telephone and mail, or frequent telephone and mail.
Measures Brief, validated, self-report measures of target behaviors were collected
at baseline and 4 months later.
Results All outcomes except vigorous physical activity improved over time, but
adolescents who received the extended interventions did not have better 4-month
outcomes than those who received only the computer and provider counseling
components. Adolescents who targeted a behavior tended to improve more than
those who did not target the behavior, except for those who targeted vigorous
physical activity.
Conclusions A primary care–based interactive health communication intervention
to improve physical activity and dietary behaviors among adolescents is feasible.
Controlled experimental research is needed to determine whether this intervention
is efficacious in changing behaviors in the short- and long-term.
From the Graduate School of Public Health (Dr Patrick) and Student
Health Services (Drs Patrick and Calfas) and Department of Psychology (Drs
Sallis, Calfas, Wilfley, and Saelens and Mr Lydston), San Diego State University,
San Diego, Calif; San Diego State University/University of California, San
Diego Joint Doctoral Program in Clinical Psychology, San Diego State University
(Mss Prochaska and Zabinski); and Division of Nutrition and Physical Activity,
Centers for Disease Control and Prevention, Atlanta, Ga (Dr Brown).
Corresponding author: Kevin Patrick, MD, MS, or James Sallis, PhD,
PACE Project, San Diego State University, 5500 Campanile Dr, San Diego, CA
92182-4701 (e-mail: kpatrick{at}mail.sdsu.edu).
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