- eating more fruits and vegetables,
- eating less saturated fats, and by
- getting more exercise.
To do this they received weekly emails encouraging them to considers specific ways along with periodic email reminders.
Of course these basic 'behavioral techniques' have been turned into a mega 'for-profit' program.
There is no need to turn this into another 'for-profit' enterprise.
This can be done freely by any media group, groups interested in health and individuals on their own.
There is no need to make a big deal of the tips or have grand 'explanations'
- just let people know specific ways they can make things better - their lives, where they live ...
What is important is tips and reminders and awareness and actually choosing to take steps for better health.
One of the tips that can be repeated in many different ways is to keep track of your progress, what you have done and notice if it is helping - if it is keep doing it, if it is not try something else.
Simply sending out on a regular basis, tips that are short, brief, to the point reminders of what individuals can do.
People that want to have better health simply need to be reminded on a regular basis they can have better health and there are plenty of simple things they can do or stop doing that can help them.]
===
- Americans have a high prevalence of “unhealthy” diets
- 77% have fewer than five servings of fruits and vegetables each day
- 77% have a fat intake greater than 30% of calories
- Americans have a low level of physical activity
- 51% fail to meet the recommended activity levels
- 24% are at the “sedentary” level
daily diet for about three-quarters of the population
consists of more than 30 percent fat,
a percentage that's generally considered too high.
recommended 30 minutes of moderate physical activity most days of the week.
for people who want to improve their diet and physical activity
changing behavior:
small goals tailored for the individual,
reinforcement, and
tracking
small health-improvement goals for themselves.
Once per week, they received an email containing individualized suggestions on ways to get closer to that goal.
suggestions were simple --
such as walking for 10 minutes each day during lunch,
walking to the store, or
eating three extra fruits per week
In between weekly suggestions, participants also received reminder emails.
Results:
more physically active,
eating more fruits and vegetables, and
reducing their intake of saturated fats and trans fats,
significantly more than those in the control group.
increased their participation in moderate intensity physical activities by almost an hour a week
decreased the amount of time they spent in sedentary activities,
like watching TV and videos, by about two hours a week.
a lasting effect
helping people move more, sit less, and make healthier food choices,weekly e-mails in their work or home accounts for four months
The e-mails linked to a personal home page with tips for achieving the small-step goals the respondent had selected, educational materials and tracking and simulation tools. Reminder messages were sent between each intervention message.
Before the program began, participants were evaluated on their eating and exercise habits
received immediate feedback.
filled out the online questionnaire twice more,
end of the program and four months later.
+++
Workplace Email Intervention Program Helps People Sit Less and Eat Better
Saturday, August 08, 2009 by: David Gutierrez, staff writer(NaturalNews) A simple intervention program featuring regular email reminders appears successful in producing healthier diet and exercise habits, according to a study conducted by health insurance firm Kaiser Permanente and funded by the U.S. Centers for Disease Control and Prevention.
"The takeaway message here for people who want to improve their diet and physical activity, and for employers who want a healthier workforce, is that email intervention programs are a very cost-effective way to get healthy," said lead researcher Barbara Sternfeld. "A tailored email program includes all the things that behavioral scientists have said for years about changing behavior: small goals tailored for the individual, reinforcement, and tracking but delivered in a mass, cost-effective way."
Kaiser researchers conducted a 16-week trial of the A Lifestyle Intervention Via E-mail (ALIVE) program on 787 employees, 351 of them in the email intervention group and 436 in a control group. All participants took a short, online questionnaire at the beginning of the study and received immediate feedback on their diet and exercise habits.
Participants in the intervention group then set small health-improvement goals for themselves. Once per week, they received an email containing individualized suggestions on ways to get closer to that goal. All the suggestions were simple -- such as walking for 10 minutes each day during lunch, walking to the store, or eating three extra fruits per week -- and were tailored to be realistic for each person's life (such as whether they had kids or a busy schedule). Each email contained a link to a Web site where participants could get extra tips, learn more and track their progress.
In between weekly suggestions, participants also received reminder emails.
According a survey completed at the end of the study and another four months later, the people in the email intervention group had increased their exercise level and fruit and vegetable intake and decreased their saturated and trans fat intake significantly more than those in the control group.
Sources for this story include: www.eurekalert.org.
===
Public release date: 19-May-2009
[ Print | E-mail |
Contact: Danielle Cass
danielle.x.cass@kp.org
510-267-5354
Kaiser Permanente
Workplace e-mail intervention program helps people sit less and eat better
Tailored e-mails suggest fruit snacks and 10-minute walks
http://www.eurekalert.org/pub_releases/2009-05/kp-wei051109.php
May 19, 2009 (OAKLAND, Calif.) – An e-mail intervention program is an effective way to significantly improve diet and physical activity by helping people move more, sit less, and make healthier food choices, according to a Kaiser Permanente Division of Research study in the American Journal of Preventive Medicine.
The study was a randomized controlled trial of the ALIVE (A Lifestyle Intervention Via E-mail) program conducted among 787 Kaiser Permanente Northern California employees at their worksites. Through the ALIVE program, developed by NutritionQuest, (www.nutritionquest.com) weekly e-mails were sent to the 351 employees randomized to the intervention group; the 436 employees in the control group received only immediate e-mail feedback at the start of the intervention indicating whether or not their reported physical activity and diet met national guidelines. The messages to the participants in the intervention group suggested small, practical, individually tailored goals, such as eating fruit for a snack three times a week, walking for 10 minutes a day at lunch time, or walking to the store instead of driving.
At the end of the 16-week trial, the participants in the intervention group were more physically active, eating more fruits and vegetables, and reducing their intake of saturated fats and trans fats, compared to the control group. The biggest changes occurred among those in the intervention group, who did not meet behavioral recommendations at the start of the trial. For example, employees who were not regularly active before receiving the intervention increased their participation in moderate intensity physical activities by almost an hour a week and decreased the amount of time they spent in sedentary activities, like watching TV and videos, by about two hours a week. These changes had a lasting effect four months after the intervention ended, the study found.
"The takeaway message here for people who want to improve their diet and physical activity, and for employers who want a healthier workforce, is that e-mail intervention programs are a very cost-effective way to get healthy," said study lead investigator Barbara Sternfeld, Ph.D., senior research scientist with the Kaiser Permanente Division of Research and the study's lead investigator. "A tailored e-mail program includes all the things that behavioral scientists have said for years about changing behavior: small goals tailored for the individual, reinforcement, and tracking but delivered in a mass, cost-effective way."
Funded by the U.S. Centers for Disease Control and Prevention, this study offers additional support for the effectiveness of the Internet and e-mail to reach large segments of the population to inspire healthier lifestyle choices. It is one of the first studies to send messages directly into individuals' e-mail inboxes, rather than requiring individuals to actively access messages via the World Wide Web.
Given that the majority of Americans eat poorly and fail to exercise enough, effective e-mail programs could be a useful way to improve health, researchers say. According to the CDC, 55 percent don't perform the recommended 30 minutes of moderate physical activity most days of the week. Additionally, the daily diet for about three-quarters of the population consists of more than 30 percent fat, a percentage that's generally considered too high.
Participants received weekly e-mails in their work or home accounts for four months that were tailored to their individual needs and life situation (for example, whether they had small children at home or busy schedules that posed barriers to exercise and diet improvement.) The e-mails linked to a personal home page with tips for achieving the small-step goals the respondent had selected, educational materials and tracking and simulation tools. Reminder messages were sent between each intervention message.
The study cohort was composed of employees who worked in the regional offices of Kaiser Permanente Northern California. The employees worked in administrative, financial, regulatory, technical and professional services and were not involved with direct patient care. They tend to use computers for much of their work. Participation had no bearing on job performance, employment status, or health benefits. The participants' information was kept confidential and did not appear on medical records or employee files.
Before the program began, participants were evaluated on their eating and exercise habits by answering a short, online questionnaire, to which they received immediate feedback. They filled out the online questionnaire twice more, at the end of the program and four months later.
Another paper published in January in the Journal of Medical Internet Research found that the ALIVE e-mail program reduced presenteeism among the trial participants and reduced bodily pain. Presenteeism is lost productivity that occurs when employees come to work but perform below par due to any kind of illness. The study did not look at whether employees used the e-mail program during their lunch hour or during their regular work hour.
"Using e-mail to get people active is a great use of existing technology that is cheap and readily available," said Bob Sallis, MD, a Kaiser Permanente family physician who is the regional exercise champion for Kaiser Permanente's Southern California region and immediate past president of the American College of Sports Medicine. "Anything we can do to increase activity level is going to improve health because we know that exercise is medicine. It's medicine you can take to live a longer and healthier life."
This study was a collaboration between Kaiser Permanente and NutritionQuest (www.nutritionquest.com), and is part of an ongoing body of research by Kaiser Permanente that looks at using technology – mobile phones, wireless PDAs, the Internet, etc. – to help individuals manage their weight, get more physically active and make healthy food choices.
Kaiser Permanente also offers its 164,000 employees and 8.6 million members free online Healthy Lifestyle programs to spur healthy lifestyle choices to prevent disease and improve health through customized online tools for weight management at www.kp.org that links with Kaiser Permanente HealthConnect™, the world's largest civilian electronic health record.
Additional researchers on the Kaiser Permanente study include: Charles P. Quesenberry Jr., Ph.D., Gail Husson, MPH, and Melissa Nelson, MA, MPH, of the Kaiser Permanente Division of Research; Torin J. Block, BA, Clifford Block, Ph.D., Jean C. Norris, DrPH and Gladys Block, Ph.D., of NutritionQuest of Berkeley, Calif.
About the Kaiser Permanente Division of Research (http://www.dor.kaiser.org/)
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR's 400-plus staff is working on more than 250 epidemiological and health services research projects.
About Kaiser Permanente Research
Kaiser Permanente's eight research centers comprise one of the largest research programs in the United States and engage in work designed to improve the health of individuals everywhere. KP HealthConnect™ , Kaiser Permanente's electronic health record, and other resources provide population data for research, and in turn, research findings are fed into KP HealthConnect™ to arm physicians with research and clinical data. Kaiser Permanente's research program works with national and local health agencies and community organizations to share and widely disseminate its research data. Kaiser Permanente's research program is funded in part by Kaiser Permanente's Community Benefit division, which in 2007 directed an estimated $1 billion in health services, technology, and funding toward total community health.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
http://clinicaltrials.gov/ct2/show/study/NCT00607009
| Sponsors and Collaborators: | Kaiser Permanente Centers for Disease Control and Prevention |
|---|---|
| Information provided by: | Kaiser Permanente |
| ClinicalTrials.gov Identifier: | NCT00607009 |
The objective of this study is to test the effectiveness of an email-based diet and physical activity intervention on increasing physical activity and fruit and vegetable consumption and decreasing intake of saturated and trans fats and added sugars.
| Condition | Intervention |
|---|---|
| Inactivity | Behavioral: ALIVE |
| Study Type: | Interventional |
| Study Design: | Prevention, Randomized, Open Label, Placebo Control, Parallel Assignment, Efficacy Study |
| Official Title: | Email-Based Diet and Activity Promotion in Worksites |
- change in physical activity [ Time Frame: 4 months ] [ Designated as safety issue: No ]
- change in fruits and vegetables [ Time Frame: 4 months ] [ Designated as safety issue: No ]
- health-related quality of life [ Time Frame: 4 months ] [ Designated as safety issue: No ]
- presentism [ Time Frame: 4 months ] [ Designated as safety issue: No ]
- stage of change [ Time Frame: 4 months ] [ Designated as safety issue: No ]
- self efficacy [ Time Frame: 4 months ] [ Designated as safety issue: No ]
| Enrollment: | 797 |
| Study Start Date: | July 2006 |
| Study Completion Date: | May 2007 |
| Primary Completion Date: | May 2007 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
| 1: Experimental received emails | Behavioral: ALIVE email-based behavioral program |
| 2: Placebo Comparator no contact | Behavioral: ALIVE email-based behavioral program |
| Ages Eligible for Study: | 21 Years to 65 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- regional Northern California KP employees
Exclusion Criteria:
- none
No publications provided by Kaiser Permanente
Additional publications automatically indexed to this study by National Clinical Trials Identifier (NCT ID):
| Responsible Party: | Division of Research, Kaiser Permanente ( Barbara Sternfeld, PhD, Senior Research Scientist ) |
| Study ID Numbers: | CN-04BSter-02-H, 5R01DP000095-03 |
| Study First Received: | January 22, 2008 |
| Last Updated: | February 4, 2008 |
| ClinicalTrials.gov Identifier: | NCT00607009 History of Changes |
| Health Authority: | United States: Federal Government |
ClinicalTrials.gov processed this record on August 07, 2009
===
Google automatically generates html versions of documents as we crawl the web.
The link to the html is here.
A Lifestyle Intervention Via Email
Block Dietary Data Systems. www.nutritionquest.com
- An intervention to improve
- Nutrition
- Physical Activity
- Developed by Block Dietary Data Systems*
- In collaboration with Kaiser Permanente of Northern California Division of Research
* Information about the developers of Alive may be found at the end of this presentation
Block Dietary Data Systems. www.nutritionquest.com
Background
- Americans have a high prevalence of “unhealthy” diets
- 77% have fewer than five servings of fruits and vegetables each day
- 77% have a fat intake greater than 30% of calories
- Americans have a low level of physical activity
- 51% fail to meet the recommended activity levels
- 24% are at the “sedentary” level
Block Dietary Data Systems. www.nutritionquest.com
Overview
- 12 weekly or bi-weekly messages
- Extensively tailored to individual characteristics
- Based on established learning and behavior-change theories and principles
- Available for groups reachable by email
- Employees, group/organization members, HMO clients
- Requires minimal organizational effort or expertise
- Proven effective in a randomized controlled trial
Block Dietary Data Systems. www.nutritionquest.com
Behavioral Goals
- Increase physical activity
- Decrease saturated and trans fats, decrease added sugars, increase good fats and carbs
- Increase fruit and vegetable intake
- Not a weight loss program
- Can be adapted to other intervention outcomes
Block Dietary Data Systems. www.nutritionquest.com
Behavior Change Principles
- Maximizing individual relevance--through assessments, feedback and tailoring
- Tailoring to stage-of-change, individual diet habits, exercise preferences
- Goal setting
- Small-steps toward new habits
- Continued feedback and reinforcement
- Increasing salience and motivation through health information, tips and reminders
- Encouraging social support
Block Dietary Data Systems. www.nutritionquest.com
Proven Effective
- Randomized controlled trial
- Funded by the Centers for Disease Control and Prevention
- 797 employees of Kaiser Permanente of Northern California
- Statistically significant increases
- Physical activity, fruits and vegetables
- Statistically significant decreases
- Saturated fat, trans fats
Block Dietary Data Systems. www.nutritionquest.com
Proven Effective
- Randomized controlled trial results paper in preparation
- Results reported in June 2007 in Oslo at the International Society of Behavioral Nutrition and Physical Activity
- The Trial website contains much more information about Alive!, and about the randomized trial:
- www.alive.kaiser.org
Block Dietary Data Systems. www.nutritionquest.com
Components
- Weekly messages contain
- Suggested goals to try for the week, tailored to each individual
- Tips for achieving the selected goals
- Tips for overcoming barriers
- Health information, information on nutrition and physical activity
- Interactive tool to explore effects of specific changes
- Links to other health/nutrition sites
- Links to track diet and physical activity
- More!
Block Dietary Data Systems. www.nutritionquest.com
Some “Health Notes” Topics
- Carbs and the Glycemic Index
- Fruits, Veggies and Cancer
- Physical Activity and Breast Cancer
- Diet and Cognitive Function
- Mood, Stress and Physical Activity
- Components of Fitness
- Trends in Physical Activity Programs
- “Good” Fats, “Bad” Fats
- and many others
Block Dietary Data Systems. www.nutritionquest.com
How it works
- Licensing agreement with Block Dietary Data Systems (BDDS)
- Organization/company promotes program to employees or membership
- Inform them that it’s approved
- BDDS can provide some promotional material
- BDDS sends invitation email to organization’s HR or other official
- Organization’s official forwards email to employee/membership list
Block Dietary Data Systems. www.nutritionquest.com
How the process begins
- Email is sent by the organization or company
- Batch email, to organization’s target group
- Email message appears in employee’s or member’s email reader
Block Dietary Data Systems. www.nutritionquest.com
Invitation Email
- Appears in employee’s inbox
- Employee ‘clicks to get started’
- This is just an opportunity to take a Health Risk Assessment and receive feedback
- Then employee receives diet and physical activity assessment
Health Risk Assessments
- Dietary and physical activity screener tools provide tailoring information
Block Dietary Data Systems. www.nutritionquest.com
Diet and Physical Activity Screeners
- Completed online in 15 minutes
- Provide instant feedback on
- Saturated fat intake
- Trans fat intake
- Added sugar intake
- Health-related physical activity
- Cardiovascular-related physical activity
- Sedentary behavior
- Available to all, free, whether they decide to participate or not
Block Dietary Data Systems. www.nutritionquest.com
Instant Feedback
- Instant feedback shows each individual how their own behavior could be improved, in relation to their current health habits
Block Dietary Data Systems. www.nutritionquest.com
Instant Feedback
- First example, person doing well in fats, less well in fruits and vegetables, so-so in physical activity
Instant Feedback
- Second example, person doing poorly in diet and physical activity
After Giving Diet and Physical Activity Results:
- Opportunity to participate in the Alive program
- If persons choose to participate, they provide email to which Alive! emails will be sent.
- May provide an alternate email if they want to participate from home as well.
Tailoring Questionnaire
- Tailoring for diet is based partially on responses to diet questionnaire
- E.g., if they report drinking whole milk, suggested goals will propose switching to lower-fat milk
- All tailoring is based on responses to lifestyle/tailoring questionnaires
- E.g., stage of change and preferences for structured or unstructured physical activity
- Or whether they cook, eating-out habits, kids at home
Participant Chooses Big Goal to Work On
- Will work on for next 12 weeks
- Can change goal in first two weeks
- By agreement, participant may rejoin at end of 12 weeks to work on same or different goal
Weekly email messages
- Come directly to participant’s email inbox
Weekly email messages
- Each week has a Health Notes (information about nutrition or physical activity and health), summarized in the weekly email by sidebar on the right
- Each week has suggested small-step goals; participant commits to one or two to try for following week
Barriers are addressed
- First weekly email lists common barriers to achieving diet (or physical activity goals)
- Participant indicates which ones are barriers for him
- Each week thereafter, tips for overcoming those particular barriers are suggested
Weekly email messages
- When participant choose a goal to work on for the following week….
After choosing weekly goal
- He is taken to his “Personal Home Page”
- Containing tailored tips to achieve the goal or goals he has chosen
Example of A Tailored Physical Activity Tip
- Physical Activity Path, “Kids at Home” sub-path
“Don’t just be a spectator at your kids’ sports activities. Walk around the field while you’re watching their soccer or baseball games. Consider helping out as a coach and do conditioning exercises with the kids. It will help all of you become more fit.”
Block Dietary Data Systems. www.nutritionquest.com
Mid-week reminder
- Reminds you of your chosen goal for the week
- Offers opportunity to go to Discussion Board
- Offers opportunity to track your diet or physical activity at US Government’s MyPyramidTracker.gov
Each week a new email
- Report how you did on your goal last week
- New goals to work on
- New Health Note topic
Each week, choose a goal for the week
- Takes participant to his personal Home Page
- For Tips
- Other tools on their Home Page
Tools on the Personal Home Page
Health Notes
- A new one each week
Progress and Goal Tracker
What-If Tool
- Tools shows participant’s actual responses to foods or physical activities
- Participant can see effects of changes
- “What if I ate hamburgers once a week instead of 5 times a week?”
- Tool shows effect of that change on participant’s total saturated and trans fats
Other Resources on Home Page
- Links to other organizations’ sites
- Library of all Health Notes
- Links to diet and physical activity tracking tools
Health Note Library
- All Health Notes from all Big Goals (Carbs/fats, Fruit/vegs, Physical Activity)
Discussion Board
- Participants can share ideas and solutions
- Can be monitored by local dietitians
More Assessment Tools
Other Options
- Family member can sign up – increases social support
Demo Version
- This Powerpoint presentation has attempted to give you a sense of Alive’s process and content. A Demo Version of Alive! is also available, in which you can have a first-hand experience all of the features of Alive!, fast-forwarding through the weeks of the program.
- Contact Block Dietary Data System. (See contact information in last slide.)
Block Dietary Data Systems. www.nutritionquest.com
Reports
- Reports can be provided to clients
- What proportion participated in Alive!
- Age and sex distribution of participants
- Average diet and physical activity scores before and after the Alive! intervention
- Arrangements can be made for participants to re-join after the end of the 12-week program
- Discuss pricing arrangements with Block Dietary Data Systems
Block Dietary Data Systems. www.nutritionquest.com
Costs
- Pricing for the Alive! program is based on the total number of employees to whom the program is offered.
- 20 - 99 employees = $20 each.
100 - 499 employees = $15 each.
500 - 999 employees = $12.50 each.
1000 - 1999 employees = $10 each.
2000 - 4999 participants = $7.50 each
5000+ participants = $5 each - We will work with you to reach an agreement that works for you
Block Dietary Data Systems. www.nutritionquest.com
Summary: Potential of an E-Mailed
Intervention at the Worksite
- Uses an established channel of communication
- Utilizes existing social support structures
- provides sources for group support
- may produce changes in social norms
- Can reduce health care costs
- Improvements in physical activity and diet have been shown to improve productivity
- Little or no burden on management
- Once launched, Alive! runs automatically
Alive’s Developers at Block Dietary Data Systems (BDDS)
- Gladys Block, PhD, is a professor of epidemiology and Public Health Nutrition in the School of Public Health, University of California at Berkeley and is the senior-scientist for BDDS. She is internationally known for her work in nutritional epidemiology and health promotion through dietary interventions.
- Clifford H. Block, PhD, is a research psychologist whose work has involved the use of information technologies for achieving behavior change in such fields as maternal and child health nutritional practices, oral rehydration, and AIDS and drug abuse prevention.
- Torin Block, BA, is the Manager of BDDS. He has 13 years of experience in the development and analysis of dietary questionnaires. He is responsible for the design and development of the electronic questionnaires, analysis algorithms and data management systems, and for the technical aspects of Alive!.
Alive’s Developers at Block Dietary Data Systems (BDDS)
- Jean Norris, DrPH, has a background in Public Health Nutrition and she is currently working as a scientist with BDDS. Prior to that, she worked for about 15 years as a nutritionist in community clinic settings with disadvantaged populations. She has designed food frequency questionnaires and researched hunger measurement and hardship, and has contributed her expertise to the study design of Project Alive! and the development of the dietary change interventions.
- Donald Hopkins created all the code to make Alive! work. He is a user interface designer and programmer, who developed a user interface component called "pie menus" at the University of Maryland Human Computer Interaction Lab, a game called "The Sims" for Maxis/Electronic Arts, and the OpenLaszlo video components for Laszlo Systems. He enjoys programming in Python and JavaScript, and working on the One Laptop Per Child project. He publishes a blog on his web site, "www.DonHopkins.com".
Alive’s Developers at Kaiser
- Barbara Sternfeld, PhD, was the Principal Investigator of the randomized trial that tested Alive! She is Senior Research Scientist at Kaiser Permanente (Northern California) Division of Research. Her background is in epidemiology and exercise physiology. She has conducted numerous studies that document the health effects of physical activity.
- Heather A. Clancy, BA was a Research Associate at Kaiser Permanente’s Division of Research and the Project Coordinator for Project Alive!
Block Dietary Data Systems. www.nutritionquest.com
Block Dietary Data Systems
15 Shattuck Square, Suite 288
Berkeley, CA 94704
Phone: 510-704-8514
FAX: 510-704-8996
Email: tblock@nutritionquest.com
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