Evaluation Of Preventive Interventions Research Articles

Quantifying the health burden of environmental stressors

Abstract The Burden of Disease (BoD) concept has gained increasing importance for health risk assessments, driven by the World Health Organization (WHO) and the Global Burden of Disease (GBD) studies. BoD utilizes the disability-adjusted life year (DALY) to express the population health impact of a disease, injury or risk factor. This information is essential for priority-setting in health, monitoring and evaluation of preventive interventions. However, calculating DALYs, particularly DALYs attributable to risk factors, requires a range of choices with regards to input data and methodological aspects. In this presentation we will focus on comparative risk assessment (CRA), a frequently used method to calculate the attribution of DALYs to risk factors. CRA consists of determining outcomes that are associated with a certain risk factor and relative risks of the identified outcomes as a function of exposure. This information is usually derived from systematic literature review(s). Next, information on the level of exposure in a population is required, usually by age, sex, location and/or year, and usually using a range of data sources on level of exposure. Additionally, the level of exposure associated with a minimum risk is assessed. Population attributable fractions (PAFs) are then multiplied by the relevant outcome quantity for each population subgroup to calculate the number of DALYs attributable to risk factors. Finally, mediation of risk factors through other risk factors can be taken into account. Knowledge of and uniformity in methods used to perform CRAs will facilitate the coherence and usability of estimates of the health impacts of risk factors and strengthen evidence-based decision-making in health policy. In this presentation, we will introduce the CRA approach and outline a number of innovations that are being driven by the BEST-COST project, including new methods for correlated outdoor exposures and for outdoor exposures penetrating to indoor environments.

Validation of the Sun Exposure and Protection Index (SEPI) in Greek: An Instrument for Measuring Children’s Sun Protection Propensity

Skin cancer, the most common type of cancer worldwide, has been linked to overexposure to ultraviolet radiation (UVR) without protection. As skin cancer is a preventable type of cancer, there is a pressing need to adopt health-promoting behaviors early in life. The Sun Exposure and Protection Index (SEPI) is an instrument for evaluating adults’ sun exposure habits and the propensity to increase sun protection with widely accepted validity and reliability in Swedish, English, and German. The present study aims to validate SEPI with children in Greek. Data was collected from 127 primary school students in Cyprus who completed the instrument twice within two weeks. Internal consistency calculated by Cronbach’s alpha was 0.69 for all 13 items included in SEPI. A statistically significant (p < 0.01) strong and positive correlation coefficient (Pearson’s r = 0.63) was measured between the total scores for parts 1 and 2. Test–retest stability was high and significant (ρ > 0.5, p < 0.01) for all items but one. In conclusion, the Greek version of SEPI demonstrates reasonable internal consistency, as Cronbach’s alpha is at a relatively acceptable level. It can be used for evaluating prevention interventions assessing sun exposure habits, and the propensity to increase sun protection among primary school students.

Prevention of Health Care–Associated Measles Transmission in a Pediatric Clinic

Abstract Objective Preventive measures in the setting of a suspected measles case in a hospital setting are important to stop the secondary spread. In this report, we evaluated the prevention attempts after two suspected cases of measles were reported in a pediatric clinic. Methods We evaluated prevention interventions including isolation, intravenous immunoglobulin, or measles–mumps–rubella (MMR) vaccine after two patients were diagnosed with maculopapular rash compatible with measles in the pediatric clinic. Results There were 50 patients (29 were outpatients, 21 were inpatients), 19 health care personnel (HCP), and 50 caregivers who were in contact with index cases. All of the HCP and 40 of the caregivers were immune to measles. Additional dose of MMR vaccine was recommended to five of the outpatients by phone. A total of 12 patients who were being followed up as inpatients (8 patients aged 6–12 months, 4 patients aged ≥ 12 months) were vaccinated with one dose of MMR vaccine. Only a 12-year-old male patient was admitted due to complaints suggesting measles after 14 days from discharge. It was learned that he had received a single dose of vaccine before so he was recommended an additional dose of MMR vaccine by the phone, but he did not go to the health institution on the day of the call. Conclusion Postexposure prophylaxis is effective to prevent measles transmission. Although young infants have the highest risk for transmission of measles in a health care–associated outbreak, adolescents and older children who are single vaccinated also have high risk for clinical measles.

Quality of data from cancer registries in the Eastern Mediterranean region.

Population-based cancer registries are crucial for our understanding of cancer burden and to inform cancer policy. They provide data on cancer incidence in a country or region, which aid the setting of priorities for cancer control, the monitoring and evaluation of preventive interventions, and the prediction of the future burden of cancer. When information on vital status is available, registry data allow for the estimation of population-based cancer survival, which helps researchers evaluate progress in cancer control, including early diagnosis, prompt referral, and adequate treatment. Routinely collected variables such as age, sex, stage, geographical location, and treatment can help to answer a multitude of questions about the distribution of risk factors, success of early detection efforts, and disparities in cancer survival. 1 Piñeros M Znaor A Mery L Bray F A global cancer surveillance framework within noncommunicable disease surveillance: making the case for population-based cancer registries. Epidemiol Rev. 2017; 39: 161-169 Google Scholar

Adaptación española de la Escala de Impacto de la Publicidad de Apuestas en adolescentes

Media pressure from gambling advertising has reached worrying levels. It constitutes a risk to the mental health of young people and adolescents by promoting a favourable attitude towards gambling, a higher frequency of gambling and a perception of greater accessibility. Currently, there is no instrument available to assess the impact of gambling advertising. ObjectiveThe present study aims to adapt and validate the Impact of Gambling Advertising Scale (IGAS). DesignThe IGAS scale was translated from English ensuring its linguistic, conceptual and metric equivalence. The psychometric properties were then tested. SiteComunidad Valenciana (España). Participants1724 adolescents with a mean age of 16.52 years (SD=.759). InterventionSelf-administered, paper-based questionnaire in a single measure. Main measurementsAdvertising impact, and gambling intention, severity and availability. ResultsInternal consistency and two-half reliability were good, Cronbach's α=.782 and α=.70, respectively. Confirmatory factor analysis concluded that the Spanish version replicates the original three-dimensional version. Convergent validity analyses showed direct and significant relationships with different aspects of gambling behaviour, and other predictors. ConclusionThe adapted version of the IGAS is a reliable and valid measure for the assessment of the impact of advertising on adolescents. The scale is a useful instrument for the diagnosis of risk level and the evaluation of preventive interventions.

JUVENILE DELINQUENCY AND CRIME PREVENTION

Delinquent children are extraordinary children who display significant deviation in their social adjustment and are therefore labeled as socially deviant or socially impaired. They have been discovered to have criminal tendencies and to engage in antisocial behavior. In this regard, they are similar to criminals and antisocial elements. However, in legal parlance, they are referred to as delinquents rather than criminals. The enormous increase in juvenile violence, notably killings, which began in the mid-1980s and peaked in the early 1990s, sparked widespread fear and concern among the public, prompting federal, state, and municipal governments to implement policy adjustments. For example, in response to the rise in juvenile violence and predictions of a new wave of increasingly violent youth, most states tightened their juvenile justice laws, including measures that allow, or in many cases require, children to be transferred to the adult system at younger ages and for a wider range of offences. A considerable body of research has begun to identify characteristics that may raise the risk of adolescent crime. The research has also resulted in the development and evaluation of prevention interventions.

Adolescent Health Series - Alcohol, tobacco, and other drug use among adolescents in sub-Saharan Africa: A narrative review.

Alcohol, tobacco, and other drug (ATOD) use by adolescents are major contributors to death and disability in sub-Saharan Africa (SSA). This paper reviews the extent of adolescents' ATOD use, risk and protective factors, and studies evaluating prevention interventions for adolescents in SSA. It also describes the harms associated with adolescents' ATOD use in SSA, which mainly include interpersonal violence, sexual risk behaviours, and negative academic outcomes. We use the socio-ecological model as our framework for understanding ATOD use risk and protective factors at individual, interpersonal, peer/school, and societal/structural levels. We used two strategies to find literature evaluating ATOD interventions for adolescents in SSA: (a) we sought systematic reviews of adolescent ATOD interventions in SSA covering the period 2000-2020; and (b) we used a comprehensive evidence review strategy and searched for studies that had evaluated ATOD interventions in all SSA countries between 2000 and 2020. Only two community interventions (a brief intervention and an HIV prevention intervention), out of four that were identified, were partially effective in reducing adolescent ATOD. Furthermore, only one school-based intervention (HealthWise), out of six that we uncovered, had any effect on ATOD use among adolescents. Possible reasons why many interventions were not effective include methodological limitations, involvement of non-evidence-based education-only approaches in some studies, and shortcomings in adaptations of evidence-based interventions. The scale of ATOD and related problems is disproportionate to the number of evaluated interventions to address them in SSA. More ATOD interventions need to be developed and evaluated in well-powered and well-designed studies.

Historical and projected hysterectomy rates in the USA: Implications for future observed cervical cancer rates and evaluating prevention interventions

BackgroundSEER-reported cervical cancer incidence rates reflect the total female population including women no longer at risk due to hysterectomy. Hysterectomy rates have been declining in the United States as alternative treatments have become available, which could result in an apparent increase in SEER-reported cervical cancer rates. We aimed to obtain nationally representative historical data on hysterectomy rates in USA, use trends analysis to project rates back to 1935 and forward to 2035, and then predict the impact of changing hysterectomy rates on SEER-reported cervical cancer rates. MethodsWe performed a systematic search of Medline, Embase, Premedline, Cochrane Central databases and extracted nationally-representative hysterectomy incidence data from 1965 to 2009, including data on the number of cervix-preserving (subtotal) procedures. We then projected rates back to 1935, and forward to 2035 based on trends from joinpoint regression. These rates were then used to estimate hysterectomy prevalence out to 2035, and then to predict the impact of changing hysterectomy rates on SEER-reported cervical cancer rates to 2035. We examined alternative assumptions regarding projected hysterectomy incidence rates out to 2035, including a scenario in which rates decline no further from 2009 rates, and a scenario where rates decline at twice the baseline rate. ResultsEstimated age-standardized hysterectomy incidence increased from 2.4 to 10.6 per 1000 women between 1935 and 1975. Thereafter, rates are predicted to fall to 3.9 per 1000 by 2035. Subtotal hysterectomy procedures declined from being the predominant method in 1935 to less than 12% of procedures from 1970 onwards. Consequently, holding all else constant, an increase in SEER-reported age-standardized cervical cancer incidence rates (ages 0–85+) of 9% is expected from 2009 to 2035. The predictions were minimally impacted by alternative scenarios for future hysterectomy rates. ConclusionsDeclining hysterectomy rates have implications for the interpretation of SEER-reported cervical cancer rates. A background increase in cervical cancer rates due to decreasing population hysterectomy exposure may partially offset expected decreases from recent cervical screening changes recommended by the US Preventive Services Task Force. Evaluations of new cervical cancer prevention opportunities should consider the background impact of historical and projected hysterectomy rates.

Economic evaluations of interventions for prevention of dental caries in young children

Economic evaluations of interventions for prevention of dental caries in young children

A systematic review of mental health measurement scales for evaluating the effects of mental health prevention interventions.

Consistent and appropriate measurement is needed in order to improve understanding and evaluation of preventative interventions. This review aims to identify individual-level measurement tools used to evaluate mental health prevention interventions to inform harmonization of outcome measurement in this area. Searches were conducted in PubMed, PsychInfo, CINAHL, Cochrane and OpenGrey for studies published between 2008 and 2018 that aimed to evaluate prevention interventions for common mental health problems in adults and used at least one measurement scale (PROSPERO CRD42018095519). For each study, mental health measurement tools were identified and reviewed for reliability, validity, ease-of-use and cultural sensitivity. A total of 127 studies were identified that used 65 mental health measurement tools. Most were used by a single study (57%, N = 37) and measured depression (N = 20) or overall mental health (N = 18). The most commonly used questionnaire (15%) was the Centre for Epidemiological Studies Depression Scale. A further 125 tools were identified which measured non-mental health-specific outcomes. There was little agreement in measurement tools used across mental health prevention studies, which may hinder comparison across studies. Future research on measurement properties and acceptability of measurements in applied and scientific settings could be explored. Further work on supporting researchers to decide on appropriate outcome measurement for prevention would be beneficial for the field.

Early-Life Arsenic Exposure, Nutritional Status, and Adult Diabetes Risk.

In utero influences, including nutrition and environmental chemicals, may induce long-term metabolic changes and increase diabetes risk in adulthood. This review evaluates the experimental and epidemiological evidence on the association of early-life arsenic exposure on diabetes and diabetes-related outcomes, as well as the influence of maternal nutritional status on arsenic-related metabolic effects. Five studies in rodents have evaluated the role of in utero arsenic exposure with diabetes in the offspring. In four of the studies, elevated post-natal fasting glucose was observed when comparing in utero arsenic exposure with no exposure. Rodent offspring exposed to arsenic in utero also showed elevated insulin resistance in the 4 studies evaluating it as well as microRNA changes related to glycemic control in 2 studies. Birth cohorts of arsenic-exposed pregnant mothers in New Hampshire, Mexico, and Taiwan have shown that increased prenatal arsenic exposure is related to altered cord blood gene expression, microRNA, and DNA methylation profiles in diabetes-related pathways. Thus far, no epidemiologic studies have evaluated early-life arsenic exposure with diabetes risk. Supplementation trials have shown B vitamins can reduce blood arsenic levels in highly exposed, undernourished populations. Animal evidence supports that adequate B vitamin status can rescue early-life arsenic-induced diabetes risk, although human data is lacking. Experimental animal studies and human evidence on the association of in utero arsenic exposure with alterations in gene expression pathways related to diabetes in newborns, support the potential role of early-life arsenic exposure in diabetes development, possibly through increased insulin resistance. Given pervasive arsenic exposure and the challenges to eliminate arsenic from the environment, research is needed to evaluate prevention interventions, including the possibility of low-cost, low-risk nutritional interventions that can modify arsenic-related disease risk.

A hospital-based birth defects surveillance system in Kampala, Uganda

BackgroundIn 2010, the World Health Assembly passed a resolution calling upon countries to prevent birth defects where possible. Though birth defects surveillance programs are an important source of information to guide implementation and evaluation of preventive interventions, many countries that shoulder the largest burden of birth defects do not have surveillance programs. This paper shares the results of a hospital-based birth defects surveillance program in Uganda which, can be adopted by similar resource-limited countries.MethodsAll informative births, including live births, stillbirths and spontaneous abortions; regardless of gestational age, delivered at four selected hospitals in Kampala from August 2015 to December 2017 were examined for birth defects. Demographic data were obtained by midwives through maternal interviews and review of hospital patient notes and entered in an electronic data collection tool. Identified birth defects were confirmed through bedside examination by a physician and review of photographs and a narrative description by a birth defects expert. Informative births (live, still and spontaneous abortions) with a confirmed birth defect were included in the numerator, while the total informative births (live, still and spontaneous abortions) were included in the denominator to estimate the prevalence of birth defects per 10,000 births.ResultsThe overall prevalence of birth defects was 66.2/10,000 births (95% CI 60.5–72.5). The most prevalent birth defects (per 10,000 births) were: Hypospadias, 23.4/10,000 (95% CI 18.9–28.9); Talipes equinovarus, 14.0/10,000 (95% CI 11.5–17.1) and Neural tube defects, 10.3/10,000 (95% CI 8.2–13.0). The least prevalent were: Microcephaly, 1.6/10,000 (95% CI 0.9–2.8); Microtia and Anotia, 1.6/10,000 (95% CI 0.9–2.8) and Imperforate anus, 2.0/10,000 (95% CI 1.2–3.4).ConclusionA hospital-based surveillance project with active case ascertainment can generate reliable epidemiologic data about birth defects prevalence and can inform prevention policies and service provision needs in low and middle-income countries.

Qualitative evaluation of a preventive intervention for the offspring of parents with a history of depression

BackgroundMeta-analyses of randomised controlled trials suggest that psychological interventions to reduce children’s risk of depression are effective. Nevertheless, these effects are modest and diminish over time. The Medical Research Council recommends a mixed-methods approach to the evaluation of complex interventions. By gaining a more thorough understanding of participants’ perspectives, qualitative evaluations of preventive interventions could improve their efficacy, longevity and transfer into clinical practice.Methods18 parents and 22 children who had received a 12-session family- and group-based cognitive-behavioural intervention to prevent youth depression as part of a randomised controlled trial took part in semi-structured interviews or a focus group about aspects which had been perceived as helpful, elements they were still using after the intervention had ended, and suggestions they had for improving the intervention.ResultsThe chance to openly share and discuss their experiences of depression within and between families was considered helpful by both children and parents. Children benefitted the most from learning coping strategies for dealing with stress and many still used them in everyday life. Parents profited mostly from increasing positive family time, but noted that maintaining new routines after the end of the intervention proved difficult. Participants were generally content with the intervention but commented on how tiring and time consuming it was.ConclusionsManaging parents’ expectations of family-based interventions in terms of their own mental health needs (versus those of their children) and leaving more room for open discussions may result in interventions which are more appealing to participating families. Increasing intervals between sessions may be one means of improving the longevity of interventions.Trial registrationThe original RCT this evaluation is a part of was registered under NCT02115880.

MHealth Approaches in Managing Skin Cancer: Systematic Review of Evidence-Based Research Using Integrative Mapping.

BackgroundmHealth, which encompasses mobile health technologies and interventions, is rapidly evolving in various medical specialties, and its impact is evident in oncology. In particular, mHealth has established itself as a prominent part of dermatology for cancer screening. Intensified research to seek its use and effectiveness in each phase of the skin cancer continuum is needed in this fast-growing field of teledermatology.ObjectiveThe purpose of this review was to describe current trends in research addressing the integration of mHealth and its contributions across the skin cancer continuum.MethodsA systematic review framework was applied to the search using three electronic databases: PubMed, Web of Science, and Embase. We extensively reviewed appropriate studies regarding skin cancer and mobile technology published between 2007 and 2017. Studies of the role and impact of mobile technology in the prevention and management of skin cancer were included. We selected 18 studies adhering to the inclusion and exclusion criteria for analysis.ResultsOf the 18 studies, 5 (28%) evaluated prevention interventions, 6 (33%) assessed diagnostic accuracy, and 7 (39%) pertained to feasibility in the context of mHealth approaches for skin cancer care. These studies portray the potential of mobile teledermatology in the prevention and management of skin cancer. However, not all phases of skin cancer involve mHealth, and not all have been addressed by research.ConclusionsThis review extends our knowledge not only on the contributions of mHealth technologies, but also on their integration in different phases of skin cancer care. To optimize the effectiveness of mHealth in dermatology, larger numbers of robust, evidence-based studies on teledermatology implementations, distributed evenly across the care continuum, should be conducted so that research can be expanded to systematic reviews.

Evaluation of occupational therapy workshops to prevent work-related injuries or illnesses among vocational students

ABSTRACTThe few studies aiming to evaluate prevention interventions provided by occupational therapists in health at work were conducted in work settings. However, to intervene in primary prevention, developing occupational therapy interventions with students learning a trade is relevant. The objective is to evaluate workshops designed and set up by occupational therapists on vocational students’ preventive behavior at work. A systematic approach was used to design and set up the prevention workshops for students of cooking and hairstyling programs. Evaluation focused on three variables: (1) satisfaction with workshops, (2) apprenticeship, and (3) behavior observed. Results were positive on the three variables. Also, students who took part in the workshops showed near 15% (p < 0.05) more preventive behavior than those who received the traditional prevention training only. This study supports the effective role of occupational therapists to promote vocational students’ preventive behavior at work. The promising results open the door to the arrival of occupational therapists in vocational training centers.

Cluster-randomised controlled trial to assess the effectiveness and cost-effectiveness of an obesity prevention programme for Chinese primary school-aged children: the CHIRPY DRAGON study protocol

IntroductionChildhood obesity in China has increased more rapidly and over a shorter time period than in other countries. However, there is a paucity of rigorously developed and evaluated prevention interventions....

Development and psychometric evaluation of a condom use self-efficacy measure in Spanish and English

Background: Condom self-efficacy is an important construct for HIV/STI prevention and intervention. A psychometrically sound measure of the self-efficacy for using condoms that has been designed for Hispanic women to respond in Spanish or English is needed.Objectives: The goal of this study was to develop and evaluate a brief self-report measure of condom use self-efficacy.Methods: We developed a 15-item measure of condom use self-efficacy based on expert knowledge of measurement and HIV/STI prevention with Hispanic women using a translation-back translation approach. Participants were 320 Hispanic women from the Southeastern US.Results: Internal consistency of the full measure was 92. A short form of the instrument with a subset of five items also had acceptable internal consistency, alpha = .80, and was significantly correlated with the full scale, rs = .93, p < .001. A single latent factor explained 9–48% of the variation in these items. Evidence of construct validity of the short form was provided by correlations of the scale with two self-report measures of condom use: rs = .34** with condom use, rs = .37** with condom use during vaginal sex.Conclusions: Either the full measure or the five-item measure could be used in studies where condom use is an important behavioral outcome, such as evaluating prevention interventions, with Hispanic women. Future studies should examine the performance of this measure with other groups, including Hispanic men and members of other ethnic and language groups.

Suicide prevention strategies revisited: 10-year systematic review

Many countries are developing suicide prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the effectiveness of suicide prevention interventions since 2005. We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest, namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identification of at-risk individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-analysis, we present a narrative analysis. We identified 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots for suicide by jumping (reduction of 86% since 2005, 79% to 91%). School-based awareness programmes have been shown to reduce suicide attempts (odds ratio [OR] 0·45, 95% CI 0·24-0·85; p=0·014) and suicidal ideation (0·5, 0·27-0·92; p=0·025). The anti-suicidal effects of clozapine and lithium have been substantiated, but might be less specific than previously thought. Effective pharmacological and psychological treatments of depression are important in prevention. Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care, in general public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions. In the quest for effective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the individual level and the population level should be assessed with robust research designs. The Expert Platform on Mental Health, Focus on Depression, and the European College of Neuropsychopharmacology.

Pathological Internet Use Is on the Rise Among European Adolescents

PurposeIncreased Internet accessibility has been accompanied by an increased awareness of pathological Internet use (PIU). The aim of the study was to investigate a potential increase of PIU among European adolescents. MethodsComparable data from two large cross-sectional multicentre, school-based studies conducted in 2009/2010 and 2011/2012 in five European countries (Estonia, Germany, Italy, Romania, and Spain) were used. The Young's Diagnostic Questionnaire was used to assess the prevalence of PIU. ResultsThe comparison of the two samples provides evidence that the prevalence of PIU is on the rise (4.01%–6.87%, odds ratio = 1.69, p < .001) except in Germany. Comparison with data on Internet accessibility suggests that the rise in prevalence of adolescent PIU may be a consequence of increased Internet accessibility. ConclusionsOur findings are the first data to confirm the rise of PIU among European adolescents. They definitively warrant further efforts in the implementation and evaluation of preventive interventions.

Improved eating behaviours mediate weight gain prevention of young adults: moderation and mediation results of a randomised controlled trial of TXT2BFiT, mHealth program

BackgroundExplanatory evaluation of interventions for prevention of weight gain is required beyond changes in weight, to determine for whom the intervention works and the underlying mechanisms of change. It was hypothesised that participant characteristics moderate intervention effect on weight change and improved eating and physical activity behaviours during the 3-month program mediate the relationship between intervention and weight.MethodsIn our randomised controlled trial, young adults at risk of weight gain (n = 250) were assigned either to an intervention group that received a 3-month mHealth (TXT2BFiT) program with 6-month maintenance or to a control group. Data were collected via online self-report surveys. Hypothesised moderators and mediators of the intervention effect on weight were independently assessed in PROCESS macro models for 3 and 9-month weight change.ResultsMales (P = 0.01), mid-20s age group (P = 0.04), and higher income earners (P = 0.02) moderated intervention effects on weight change at 3-months and males only at 9-months (P = 0.02). Weight change at 3 (−1.12 kg) and 9-months (−1.38 kg) remained significant when 3-month nutrition and physical activity behaviours were specified as mediators (P <0.01 and P = 0.01 respectively). Indirect paths explained 39 % (0.72/1.85 kg) and 40 % (0.92/2.3 kg) of total effect on weight change at 3 and 9-months respectively. Increased vegetable intake by intervention group at 3-months accounted for 19 and 17 % and decreased sugar-sweetened beverages accounted for 8 and 13 % of indirect weight change effects at 3 and 9-months respectively.ConclusionsTXT2BFiT was effective for both young men and women. Small sustained behavioural changes, including increased vegetable intake and decreased sugar-sweetened beverages consumption significantly mediated the intervention’s effects on weight change. Improved eating behaviours and increased physical activity accounted for approximately 40 % of the weight change.Trial registrationThe trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612000924853).