Location: Delta Obesity Prevention Research2013 Annual Report
1a. Objectives (from AD-416):
The mission of the Delta Obesity Prevention Research Unit is to conduct nutrition research to prevent obesity in at-risk, rural populations in the Lower Mississippi Delta of Arkansas, Louisiana, and Mississippi. The Agricultural Research Service (ARS) is coordinating a major research endeavor that brings together the talents of ARS and other research cooperators in a tri-state region to accomplish the following: 1) Identify barriers and facilitators to adherence to the Dietary Guidelines for Americans (DG) and examine how differential profiles of adherence relate to obesity in children and adults of the Delta region (ARS HEALTH study); 2) extend the behavioral knowledge gained from ARS research studies and other food availability and food cost surveys in the Delta, to adapt existing DG eating patterns, such as the USDA Food Guide (MyPyramid) and the DASH Eating Plan, for the Lower Mississippi Delta population. Test the developed eating patterns for nutritional adequacy and feasibility of adoption by the Delta population. Concurrently, adapt DG physical activity recommendations for the Delta population and examine feasibility of adoption; 3) evaluate the effectiveness of the adapted DG eating patterns, with and without physical activity, in reducing weight gain and risk factors for obesity-related chronic disease in the Lower Mississippi Delta population through the use of interventional studies. Determine if diet-gene relationships underlie the effectiveness of the adapted eating patterns.
1b. Approach (from AD-416):
The Delta Obesity Prevention Research Unit, in partnership with other ARS laboratories and research cooperators, has developed a strategic plan to improve the health of at-risk, rural populations of the Lower Mississippi Delta through obesity prevention research. Utilizing multi-faceted research approaches, this endeavor will provide a greater understanding of this population’s adherence to national dietary guidance for prevention of obesity and reduced risk for obesity-related chronic disease through the use of dietary and physical activity interventions using established scientific study designs and methods meeting the requirements for evidence based reviews. This cooperative research seeks solutions to these complex challenges through multidisciplinary team research and through cooperation with the general public, local government, policy makers, other institutions and agencies. Research internships addressing the objectives above may be created for university students in the tri-state area.
3. Progress Report:
Research was conducted to understand how food choices and PA behaviors can be changed or improved through a culturally tailored intervention. Ways to Enhance Children’s Activity and Nutrition (We CAN!), a national education program developed by the National Institutes of Health (NIH). was culturally tailored. We CAN! Louisiana was designed for parents and caregivers to help youth ages 8-13 maintain a healthy weight. The project was conducted in three phases: Phase I – Formative Evaluation - Twelve focus groups (86 parents and 70 children) were held in St. Landry and East Carroll (LA) parishes to gain insight into cultural influences on dietary and PA patterns, overweight/obesity in African American population, and intervention materials and delivery preferences. This information was used to design the culturally tailored nutrition/PA curriculum for parents and children. Focus group discussions were audio recorded, transcribed, and analyzed to identify relevant themes. A summary focus group report was prepared. Phase II – Feasibility Study - The purpose of the feasibility study was to determine if the planned intervention will meet the stated objectives. Further, the feasibility study guided the development of the study procedures to enable reliable answers to the research questions. It consisted of a pre-post design conducted in a community not in close geographic proximity to the sites for the main study during June through September 2011. The 12-week feasibility study included 18 parents/caregivers/child dyads. These parents/caregivers and children were assigned to one of two groups (intervention and control). All procedures and data collection questionnaires and outcomes assessment measurements were tested. Focus group data were used to determine approaches for developing a culturally tailored curriculum for adopting the DG for the target population. Program content and activities from the We CAN! nutrition education program was the basis for the curriculum for the intervention. We CAN! Louisiana focused on teaching parents how to help their children improve food and PA behaviors. The culturally tailored curriculum incorporated beliefs, values, issues, and scenarios related to the target population to make it more culturally familiar. The intervention curriculum was delivered by a baccalaureate level healthy lifestyle promoter who received comprehensive training for implementing the culturally tailored curriculum. The intervention group parents received the culturally tailored curriculum aimed at increasing adherence to the healthful food and PA patterns set forth in the DG. The parent intervention consisted of ten 90-minute weekly sessions for parents. The intervention with children consisted of two 2-hour sessions held twice a month. Control group parents received the 2011 consumer handbook, "Let's Eat for the Health of it" published by the U.S. Department of Health and Human Services and the USDA, and the Dietary Guidelines for Americans 2010. Control group children received Team Up at Home: Team Nutrition Activity Book, published by the USDA, Food and Nutrition Service. Both process and formative evaluation were used to determine the success of the feasibility study in promoting adherence to the fruit, vegetable, fat, and PA recommendations of the DG and for revising the program as appropriate to increase its effectiveness. Components of the evaluation model included recruitment and training procedures, attendance, participant handbooks; healthy lifestyle promoter leader's handbook; increase in HEI scores; increase in physical activity; change in nutrition knowledge. A reconciliation of this evaluation was used to revise the intervention curriculum for the main study. This year, we implemented Phase III – Main Study Implementation. The team conducted the culturally tailored We CAN! curriculum designed to increase the adoption of Dietary Guidelines for Americans eating and physical activity patterns for preventing weight gain and risk factors for obesity-related chronic diseases in Lower Mississippi Delta African-American parents and children. We CAN! is a national education program designed by the National Heart, Lung, and Blood Institute (NHLBI) to give parents and caregivers a way to help children 8 to 13 years old stay at a healthy weight, with focus on improving food and physical activity behaviors. The culturally tailored intervention incorporated beliefs, values, issues, and scenarios related to the target population to make it more culturally familiar. The main study was a pre-post design conducted with 53 parent/caregiver/child dyads (parent/caregiver and child in the same family). Recruiting and enrolling participants into the study was a challenge. A variety of approaches were used, including outreach and direct appeal and various media venues, i.e., newspaper, radio, and television. Following baseline data collection, randomization of participants to the treatment conditions occurred. Each parent/child participant signed an Institutional Review Board (IRB) human subjects' protection form (informed consent form). The full 24-week adapted We CAN! Louisiana curriculum served as the vehicle for implementing the intervention. We CAN! Louisiana was supplemented with information identified by the focus group participants and research team in Phase I and from the Feasibility Study in Phase II of the project. Focus groups provided perceptions and beliefs relative to concepts such as health, specific Dietary Guidelines, relationship of Dietary Guidelines and diseases, spirituality, social support, and the importance of family in adopting the Dietary Guidelines. The 12-week feasibility study was a pre-post design intervention conducted in a community not in close geographic proximity to the sites for the main study. The parent/caregiver/child dyads were assigned to one of two groups, intervention and control. The intervention group parents received the culturally tailored curriculum, We CAN! Louisiana: Families Finding the Balance Handbook aimed at increasing adherence to the healthful food and physical activity patterns set forth in the Dietary Guidelines. The intervention consisted of 24 90-minute weekly sessions for parents. The intervention with the children consisted of two 90-minute bi-monthly sessions encouraging healthy eating, increased physical activity, and reduced time sitting in front of the screen (TV or computer). The intervention group children received the We CAN! Louisiana: Families Finding the Balance Children's Handbook. The children's intervention sessions served as reinforcement for the parental instruction. The intervention also included a garden component for both parents and children. The control group parents received the Parent Control Handbook consisting of a collection of 16 lessons on parenting principles and money management. The control group children received the Healthy Children: Healthy Futures Handbook, consisting of a collection of eight lessons on health, safety, and coping information. The control groups only met once to receive the handbooks. The intervention was delivered by baccalaureate level healthy lifestyle promoters. The effectiveness evaluation of the intervention combined anthropometric, nutritional, and dietary assessment in the intervention with biological assessment for biomarkers associated with chronic disease risks related to obesity, e.g., hypertension, hyperglycemia, coronary heart disease. Three assessment periods were completed for data collection: baseline, mid-point, and post-intervention. Baseline and post intervention data collection included height, weight, waist circumference, body fat, blood pressure, and biomarkers (glucose, hemoglobin A1C, total cholesterol, HDL cholesterol, LDL cholesterol), and survey data including food intake (three 24-hour recalls), physical activity (Bouchard Three-day Physical Activity Record), parent self-efficacy, parenting styles, social support for eating and physical activity, and body image of parents and children. Physical activity data were collected using an accelerometer. Mid-point data collection included weight, waist circumference, and blood pressure. After the post intervention data collection, all data will be cleaned, double entered, and systematically checked for accuracy. Prepared data will be sent to Pennington Biomedical Research Center for processing and statistical analyses. The 24-hour dietary recalls analyses will also be conducted at Pennington. This research will contribute empirical data on the effectiveness of the We CAN!. Results from this study will be translated to public health improvements. Other customers include health researchers and practitioners who may use these findings in tailoring interventions to communicate DG messages for changing food intake and PA patterns in similar groups. It will provide qualitative and quantitative data for the literature to compare with similar studies regarding the impact of a lifestyle intervention on physiological measures related to overweight/obesity in rural African Americans. Qualitative data can be used to generate additional research questions for scientific assessment analyses. The results of this study can be used to increase the understanding of determinants for compliance with the DG for targeted and similar groups.