Harvey, Jean What do Men Really Want?: A Crowdsourcing Approach to Understand Weight Loss Behavior in Men
National Institute of Food and Agriculture
Currently men are underrepresented in the weight loss treatment literature. Men are less likely to participate in obesity treatment interventions, are less likely to engage fully when they do and are less likely to lose clinically significant amounts of weight. Men however, have nearly the same prevalence of overweight and obesity as women and suffer the same degree of morbidity and mortality because of it. There is a clear and urgent need to identify evidence based approaches and program
components that can effectively engage men in initial weight loss and successful long-term weight loss maintenance. Therefore, the objective of this study is to use an innovative technique called ""crowdsourcing"" to understand why men do not seek out and participate in weight loss interventions. Web-based crowdsourcing is a rather anonymous, fast and inexpensive method to generate new hypotheses and discover unexpected issues that might have been overlooked by professionals.
Crowdsourcing may therefore, help to detect possible unexpected beliefs about obesity and may identify unpredicted barriers to weight loss in men. Ultimately, the information gathered will be used to develop and launch new targeted obesity treatment programs for men.
Heiss, Sarah Pursuasion, dieticians, and sponsors in the Academy of Nutrition and Dietetics
National Institute of Food and Agriculture
The current examined interactions between registered dieticians and the food industry. The goal was to identify the types of messages exchanged between dieticians and food industry representatives and evaluate how these messages help or hinder the respective organizations’ missions. Data for this project was collected and analyzed October 2014. Specifically, we interviewed 25 registered dieticians (RDs) and collected ethnographic data at the 2014 Food and Nutrition Conference and Expo hosted by the Academy of Nutrition and Dietetics. We found that dieticians find it difficult to discern between informational and persuasive messages when talking to food industry representatives. We also identified several strategies that dieticians are currently use to manage the influence of food industry on their professional practice.
This work is relevant to Vermont because our findings provide professional development opportunities for our state’s many RDs and nutritionists. We provide a set of recommendations for how to teach nutritional communication and message discernment to food and diet professionals. This information can be shared at professional conferences and incorporated into formal training curriculum.
By helping to improve the communication of RDs and nutritionists our results help these professionals share more accurate information with the state’s constituents and, therefore, help to improve the health of our state.
Johnson, R. Web-based training in digital imaging to measure fruit and vegetable consumption in schools
National Institute of Food and Agriculture
The majority of U.S. children do not meet recommendations for fruit and vegetable (FV) consumption. FV confer numerous health benefits including intake of critical shortfall nutrients, reduced risk of chronic diseases, and maintenance of healthy weights. Identifying policy and behavioral approaches to increase children’s consumption of a variety of FVs has become a public health priority. When evaluating policy and interventions it is important to apply validated dietary assessment methods to measure FV selection, consumption, and waste. Our research aims addressed the feasibility of dietary assessment methods and their application to evaluate policy change and behavioral interventions.
We applied validated dietary assessment methods to evaluate the effect of national school lunch policy change on elementary school children’s FV consumption. As of the 2012 school year, the United States Department of Agriculture (USDA) requires school children to select either a fruit or a vegetable with a reimbursable meal. We compared children’s FV choices in two school cafeteria environments a year before these new USDA regulations took effect. Elementary school (grades 3-5) children’s FV choices were measured during Spring 2011 at two northeast elementary schools (NES-A and NES-B). NES-A had a self-serve salad bar, whereas NES-B served pre-portioned FV and pizza daily. Of 555 trays assessed (n=284 NES-A, n=271 NES-B), 15.3% (n=85) had no FV selected. A higher percentage of trays from NES-A had no FV (23.6%, n=67) in comparison to NES-B (6.6%, n=18) (P<0.0001). On average children selected more processed FV (PFV) (80.8g) than whole FV (WFV) (40.5g, P<0.001). The mean amount of FV selected was lower in NES-A (111.4g) than NES-B (131.5g, P<0.01). When trays without a FV were removed, quantities selected were not significantly different between schools (P=0.46). For PFV, 100% fruit juice was on 41.4% of trays (n=230) and pizza was on 42.1% of NES-B trays (n=114). Trays with pizza or 100% fruit juice were less likely to have a WFV (P<0.001, P<0.0001 respectively). In the second study, elementary school children’s FV selection, consumption and waste were compared in two northeast elementary schools before the USDA rule in spring 2012 (10 school visits, tray observations n=498) and following the USDA rule in spring 2013 (11 school visits, tray observations n=944). More children selected FVs in higher amounts when FVs were required compared to when they were optional (0.69 cups vs. 0.89 cups, P<0.001); however, consumption decreased slightly (0.51 cups vs. 0.45 cups, P=0.01) and waste increased (0.25 cups vs. 0.39 cups, P<0.001).
We also addressed the feasibility of non-research volunteers (teachers and parents) collecting digital imaging (DI) dietary assessment data in a sample of elementary schools. Two Northeast Elementary Schools (NES-A and NES-B) were recruited and a parent-based dietary assessment team (PDAT, n=5) and teacher based dietary assessment team (TDAT, n=4) were formed. We compared data collected by the PDAT and TDAT with the university-based dietary assessment team (UDAT). Feasibility was measured based on the total number of DI pairs collected out of the total number of eligible DI pairs across all data collection days for each of the three teams. Using binary logistic regression, at NES-A, the PDAT was less proficient at collecting DI pairs (74.1%, n=218 of 294 LD) than the UDAT (81.9%, n=262 of 320 LD, P<0.05). At NES-B, the TDAT was better able to capture DI pairs (95.9%, n=257 of 268 LD) than the UDAT (91.3%, n=366 of 401 LD, P<0.05). We concluded that teachers may be better able to collect dietary assessment data from school children compared to university researchers and parent volunteers.
Johnson, R. Acceptance of Reformulated Flavored Milk in Schools
Dairy Management, Inc.
Milk is an important source of shortfall nutrients in children’s diets, however most children do not consume recommended amounts. This research aimed to measure children’s milk acceptance as flavored milk formulations changed in anticipation of USDA’s new school nutrition regulations. As of the 2012/13 school year, the new regulations set calorie maximums for meals, and limited milk offerings to low-fat or fat-free unflavored white milk and if flavored, fat-free.
The major findings of our research were:
• As flavored milks offered in school initially changed to lower calorie versions (<150 cal/8oz), elementary students were as likely to drink most of their milk (>7 oz) compared with students drinking higher fat or sugar flavored milk (160-170 cal/8oz).
• Adjusting for region, grade and sex, flavored milk consumption did not change from 2010 to 2013 (when flavored milk was required to be fat-free), with 52.2% and 49.7% of students consuming most of their milk respectively (>7 oz).
• From 2009-2014, elementary students (grades 3-5) consumed an average of 5.4 oz of flavored milk with lunch (annual range: 5.3 - 6.0 oz).
• As the calories in flavored milk varieties offered in schools were reduced (by 20-30 calories/8 oz), student participation in the National School Lunch Program (NSLP) initially declined, but recovered over time. No changes were seen in milk shipments (flavored and unflavored).
• While student eligibility for free and reduced priced meals increased from 2010 to 2013, NSLP participation declined (mean difference=-5.4, p<0.0001). Adjusting for this decline in NSLP participation, average daily milk shipment per school increased (mean difference=116 units of milk, p<0.0001).
• From 2010 to 2013, average daily milk shipment per student increased from 0.89 units/student to 1.05 units/student (p<0.0001). This increase may be related to efforts to expand school meal offerings, including school breakfast programs.
• While most of the school nutrition directors (SNDs) participating in this research felt prepared for USDA’s new school meal regulations, they were concerned about increased food costs and anticipated declines in student participation in school meals. Most believed that students would adjust to the new regulations over time, but there were lingering concerns about the influence of the food environment outside of school.
• As a cost saving measure, the two school districts that offered milk in plastic bottles, switched to paperboard cartons. Student milk consumption declined in the southern district; nutrient modeling suggested that these declines resulted in students no longer meeting IOM targets for calcium and potassium. Milk consumption did not change in the northern district when plastic bottles were discontinued.
• While not unanimous, the new school meal regulations were perceived positively, however SNDs felt there wasn’t adequate time to fully prepare for the implementation schedule.
The school environment offers important opportunities for children to consume two of their three daily recommended milk servings. However, participation in the NSLP has declined since 2010. Milk, including flavored milk, makes a significant contribution to children’s daily intake of Vitamin D, calcium and potassium. Study findings provide further insight into the challenges that SNDs need to overcome for successful implementation of programmatic changes, most notably cost management and procurement of foods compliant with USDA’s new regulations that children will accept. Updated school meal standards succeeded in lowering fat content, added sugars and calories in school milk without changing overall milk consumption, thus improving children’s diet quality.
Johnson, R. Evaluation Project of the American Heart Association Teaching Gardens Pilot Program
American Heart Association - National
The American Heart Association (AHA) set a Health Impact Goal of improving the cardiovascular health of all Americans by at least 20 percent by 2020. Among strategies to reach this goal, the AHA developed the Teaching Gardens program to launch school gardens across the United States. Teaching Gardens provide school children with opportunities to learn about food and nutrition while planting, maintaining, harvesting, and preparing fruits and vegetables from their school garden.
The purpose of this study was to apply Social Cognitive Theory and evaluate the impact of AHA Teaching Gardens on students’ preferences, self-efficacy, food systems learning (FSL), gardening skills, and social norms with regards to the consumption of fruit and vegetables (FV). This study took place over three years from 2012 - 2014.
Twenty-three schools that were awarded funding from the AHA to begin Teaching Gardens were invited to participate in the study. Teachers were instructed to administer surveys to their students one week prior to planting or any other garden activities and again to the same group of students within one week of harvesting the garden. Among the 23 participating schools, 17 returned pre-test responses (n = 755), and 18 returned post-test responses (n = 976).
Two schools were selected by the AHA in consultation with the research team to act as control schools (pre-test, n = 173; post-test, n = 146). Students at the control schools were also provided the pre- and post-test survey questionnaires but did not participate in any gardening activities.
Frequencies and cross-tabulations were used to analyze pre- and post-test data for the sample. Paired t-tests were used to analyze differences between pre- and post-test when data were collected for the same student (n= 180) before and after the Teaching Gardens implementation and found no statistically significant differences from pre-test to post-test on any index. No significant differences were observed for any index among the Control group (n=91).
Mean index scores from unmatched pairs of students (n= 575 at pre-test, n=793 at post-test) increased in Food Systems Learning and Social Norms and decreased in Gardening Skills for the Experimental group. No significant changes were found for the Control group (n=80 at pre-test, n=55 at post-test).
At post-test, significant differences by sex were found in responses across all five indices. Overall, girls answered more positively to questions compared to boys.
Crosstab results also indicated significant differences by the percent of students eligible for Free or Reduced Price Lunch (FRPL) across all five indices at post-test. However, the effects of this environmental factor were mixed. Students at schools with higher FRPL eligibility were more likely to answer positively to Food Systems Learning and Social Norms questions, while students from schools with lower rates of FRPL eligibility were more likely to answer positively to questions on Gardening Skills and Self-Efficacy. Significant differences were also found for questions related to Preferences, but were mixed.
Consistent with previous studies, the Teaching Gardens program had mixed results on the determinants of participants’ health behavior. The differences by sex and by FRPL eligibility suggest that the Teaching Gardens program affects different groups in different ways. Further research is needed to examine how the Teaching Gardens program impacts students’ fruit and vegetable consumption over time, and how this program and others like it can be tailored to meet the different needs of different populations of students.
Kolodinsky, Jane Community Behavioral Health Pilot
Michigan State University
Grappling with behavioral health problems, especially substance use and mental health issues, is a continual struggle for many communities across the country. A particular challenge for community leaders is that the occurrence of these issues varies tremendously from location to location. Therefore, it is important for local leaders to have access to accurate data about behavioral health problems in their specific geographic location. Chittenden County was selected as a pilot community for nationwide project funded by the United States Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) and the US Department of Agriculture. The CAPE Project (Community Assessment and Education to Promote Behavioral Health Planning and Education) explored how local health decision-makers gain information on the behavioral health problems in their communities and how they access needed information and data for coordinating local efforts.
The CAPE project was developed to provide resources for local decision makers to get a better understanding of the behavioral health concerns in their region. UVM researchers compiled a list of community leaders from local government, health organizations, social service agencies, and other community-based organizations. The national CAPE team then surveyed these stakeholders about their perceptions of community behavioral health issues. Leaders were then convened for a community stakeholder meeting where the survey results were presented and also compared to a data profile complied by the national CAPE team. A key outcome from this community stakeholder meeting was that many organizations are interested in accessing data to inform their work but they are limited by the timeliness of the many of the available data sets. This work directly led to the development of another CAPE Project proposal that seeks to build an early warning data dashboard that utilizes more real-time data from the community. This type of data enables organizations to make more data-driven decisions regarding resource deployment and program location in nearly real-time.
Kolodinsky, Jane Nationwide Evaluation of USDA Farm to School Grants
PEER Associates
The purpose of this project is to evaluate the process, outcomes and impacts of the USDA Farm to School grant program. The specific objectives are to measure and describe:
1. The impacts of the USDA Farm to School grant program.
2. Grantee satisfaction with the quality of technical assistance provided by USDA staff.
3. Changes in purchases of local foods of all types in grantee and grantee partner schools.
4. Grantee partnerships between and within school districts and their surrounding agricultural producers.
5. Grantee incorporation of experiential nutrition education activities
6. Key strategies, barriers and best practices in beginning and sustaining farm to school programs.
7. Areas of need for future farm to school funding.
The UVM research team is working as a subcontractor to a Vermont firm, PEER Associates, to measure and describe the program results, and the USDA Farm to School program is responsible for all dissemination of results.
Kolodinsky, Jane Innovative Community Supported Agriculture Cost-Offset Intervention to Prevent Childhood Obesity
Cornell University
Community Supported Agriculture (CSA) is an innovative approach to increasing consumer access to and consumption of fresh produce, thereby lowering obesity prevalence. However, CSA ""share"" costs may be a barrier for low-income families with children, who are at increased risk for obesity. The proposed project examines whether subsidizing the cost of CSAs, integrated with tailored education: 1) increases consumption of fruits and vegetables, 2) substitutes fruits and vegetables for more energydense foods, and 3) improves overall diet quality and energy balance, thus helping children maintain healthy body weights. We will also address a current knowledge gap by examining how cost-offset CSAs (""CO-CSAs"") contribute to local agricultural economies. The research includes formative evaluation with farmers who currently have a CO-CSA program in place as well as observation of dietary behaviors among existing CO-CSA consumers. Those findings will inform implementation of a randomized trial to evaluate CO-CSA participation plus tailored education on diet and weight status among low-income families with children aged 2-19 years. The research will also include economic analysis to evaluate the impact of CO-CSA for farmers and communities. The extension components are a) adaptation and implementation of a tailored curriculum to enhance
participant knowledge, skills, attitudes, and behaviors related to use of CSA produce and strategies to promote dietary change and energy balance; and b) business plan development for farmers to support sustainability of CO-CSAs. The education component includes development and dissemination of short-courses for undergraduate and graduate students, focusing on links between local food systems and health.
Our project objectives, which integrate research, extension, and education, are to:
1. Examine whether CO-CSAs coupled with tailored nutrition education improve dietary intake and quality among children aged 2-19 in low-income households;
2. Examine the influence of CO-CSAs and tailored education on attitudes and behaviors related to nutrition, meal planning, and meal preparation;
3. Contrast CSA models to understand if and how variability in operational characteristics affect participation and intervention effectiveness in low-income families with children;
4. Estimate the economic impact of a CO-CSA program on the local economy;
5. Evaluate options for farmers to sustain the CO-CSA, and work with an advisory board, extension, and other stakeholders (e.g. CSA networks) to disseminate findings through development of a tool kit and related electronic resources to maximize impact; and
6. Develop and evaluate short-course modules and lectures for undergraduate and graduate students related to local food system innovations that are synergistic with the goal of obesity prevention and designed to enhance human capital relevant to U.S. agriculture.
We are currently in year one: formative evaluation. All project activities are occurring in four states (VT, NY, NC and WA). C.1. Formative Evaluation with all stakeholder groups to improve understanding of CO-CSA implementation and participation.
Kolodinsky, Jane Community and Public Safety Dashboard
Michigan State University
Community behavioral health problems such as opiate addiction, alcohol abuse, and mental health have detrimental effects on quality of life for the whole community. These issues are especially relevant for the Burlington community as well as others across Vermont as leaders grapple with the opiate crisis and associated issues. Partners in the greater Burlington area including the Burlington Police Department, Howard Center, University of Vermont Medical Center, United Way of Chittenden County, Champlain Valley Office of Economic Opportunity, and others (collectively known as the Chittenden County Service Executives Committee) have identified the need for community-level metrics to identify emerging areas of concern and to measure the amount of success they are collectively having on community health and law enforcement issues. The purpose of the dashboard is to serve as an early warning system that focuses in on what is working and what might not be working on these important issues as they implement programs. The early warning system will also assist in improving community and individual outcomes by being a low-cost tool to highlight or identify trends or pressure points in advance of overt signs of trouble. Local law enforcement and service providers would be able to use this timely information to adjust their own practices and implement targeted interventions.
Our team will identify and collect a set of indicators that measure current initiatives across all agencies and can aid in the proactive detection of important issues. These indicators will be linked to a set of goals to help dashboard users to understand the purpose of the measures and why they are important to the community. We will also select a dashboard solution that includes software and implementation services that will satisfy the requirements provided by the CCSEC. The CAPE 2 Team will be responsible for the creation and configuration of the dashboard, and will be responsible for providing training to staff on the use of the system. This project is part of a larger national pilot project focused on developing early warning systems to better understand and address community behavioral health problems funded by a collaboration between the United States Department of Agriculture and the United States Substance Abuse and Mental Health Service Administration.
Sun, Tao To eat breakfast like a king, lunch like a prince, and dinner like a pauper? -- Testing the Relationship between Meal Proportions and Obesith
National Institute of Food and Agriculture
When it comes to the relationship between eating and obesity, there appears to be a conventional wisdom that to keep fit and
avoid obesity, one needs to""eat breakfast like a king, lunch like a prince, and dinner like a pauper,"" an advice attributed to Adele
Davis, a once popular yet controversial American nutritionist. Due to the popularity of the much quoted statement by Davis, it is
important to test its validity so that facts can be separated from presumptions or myths. When media coverage about obesity is
extensive, many people appear to accept some presumptions or myths as facts simply because of their repeated exposure to
the claims (like the quote by Davis). The promulgation of unsupported beliefs and contradicting myths may yield poorly informed
policy decisions, inaccurate clinical and public health recommendations, and may divert attention away from useful, evidence-
based information. Thus, more research is needed, to prove or reject, with proper evidence, the popular advice by Davis. Our
project is to test the validity of this quote, through an analysis of the relationship between meal proportions and obesity, based
on the China Health and Nutrition Survey data and other data collected in the US.
Trubek, Amy Learning to Cook and Developing Food Agency: An Assessment of Deweyan Pedagogy
National Institute of Food and Agriculture
As in all areas of their lives, humans act with agency in regards to food; that is, they have “the ability to comprehend, predict, and alter the course” of their encounters with foods. However, some individuals act with more agency than others: they confidently and actively identify, pursue, and accomplish food-related goals, whereas others passively participate in the food system, taking the path of least-resistance – often to their nutritional detriment. Because food encounters and decisions do not happen in a vacuum, an individual’s “food agency” can be defined as an inventory of their individual cooking skills, self-efficacy beliefs, and social supports and constraints. The goals of this project are multiple. One is to develop a set of mixed-methods tools to identify and assess food agency. Another is to develop a “portable,” experiential pedagogy that demonstrably increases food agency. Finally, we intend to investigate the relationship between food agency and other, observable behavioral and demographic characteristics. This portable pedagogy could then become part of nutrition outreach programs throughout the Northeast, and our research will help figure out how to tailor programs to diverse population of youth in rural and urban areas.
The idea that food agency is worth increasing is implicit in a large body of popular and academic literature linking individual and public health with increased cooking skill and “food literacy”. For example, researchers connect the decrease in cooking and increase in eating outside the home with both a decrease in healthful ingredient and food consumption and an increase in the consumption of foods high in unhealthy components like sodium, saturated fats, and refined sugars. On the other hand, the scholarly literature suggests that individuals in control of their own food decisions seem to have better food and nutrition outcomes. Researchers have found that that individuals with cooking skills and involved in daily meal preparation reported eating more vegetables and lower amounts of convenience foods, even when the results were controlled for health consciousness. Further, literature reviews have shown that family meals not only lead to healthier food choices, but also to healthier and more consistent meal patterns, as well as a wide range of psychosocial benefits.
Since the launch of the research project in July 2014 we have accomplished the following: (1) Run three focus groups to explore elements of food agency as articulated by competent home cooks of all ages and income levels; (2) Developed initial scale items for a proposed quantitative food agency scale (FAS) based on focus group results; (3) Run a qualitative inquiry into food agency in on-going foods labs at UVM, including interviews, observations and videos of 8 students and a similar comparison study at Drexel University; (4) Used large-scale (N = 450) survey methodologies to propose an initial FAS of 30 items to be further tested for validity, generalizability, and reliability; (5) Run a qualitative inquiry into food agency in a foods course at Drexel University in Philadelphia with both undergraduates and community members. These initial activities have produced an empirically derived definition and both qualitative and quantitative tools for accessing and measuring food agency. The next phase of the project will comprise the development and validation of the portable, experiential pedagogy in several places and populations, as well as more fundamental research into the relationship between food involvement and demographic and behavioral measures.