Location: Delta Obesity Prevention Research2010 Annual Report
1a. Objectives (from AD-416)
Objective 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. This research is part of the ARS multi-location study entitled "Healthy Eating and Lifestyle for Total Health" (HEALTH) and will be conducted concurrently with the other ARS partners. HEALTH study locations include the Delta region plus the six ARS Human Nutrition Research Centers located in Arkansas, California, Massachusetts, Maryland, North Dakota, and Texas. Subobjective 1A. Construct conceptually and culturally appropriate survey tools to assess DG adherence barriers and facilitators for African-American and Caucasian children and their caregivers of the Lower Mississippi Delta region. Conduct a pilot test to determine the psychometric properties of the survey tools. Subobjective 1B. Examine barriers and facilitators of DG adherence and other factors as they relate to dietary behavior and body mass index by administering the surveys to cross-sections of the Lower Mississippi Delta region's population. Objective 2. Extend the behavioral knowledge gained from the HEALTH study, as well as from Foods of our Delta (FOODS 2000) and other food availability and food cost surveys in the Delta, to adapt existing DG eating patterns, such as the USDA Food Guide 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. Evaluations are to use only established scientific methods meeting the requirements for evidence-based reviews. Sub-objective 2A. Develop an incremental approach to promote specific steps toward DG adherence with new tools and technology adapted for the LMD. Sub-objective 2B. Determine the feasibility of the Delta DG Small Steps Tool Kit as a means of adapting the DG to overcome barriers and support motivators for DG adherence in the LMD. Objective 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. Only established scientific evaluation methods meeting the requirements for evidence-based reviews, such as a randomized control trial design with adequate statistical power, are to be used. Sub-objective 3A. Examine the effectiveness of a Delta DG Small Steps Tool Kit to create incremental changes in eating behaviors to support and reinforce adoption of the DG as means of preventing further obesity among LMD residents.
1b. Approach (from AD-416)
Barriers and facilitators of adherence to the Dietary Guidelines for Americans (DG) will be identified through random nominal group sessions with 5th graders and caretakers in the Delta of Arkansas, Louisiana, and Mississippi. Researchers will examine how differential profiles of adherence relate to obesity in children and adults of the Delta region. This research is part of the ARS multi-location study entitled "Healthy Eating and Lifestyle for Total Health" (HEALTH) and will be conducted concurrently with the other ARS partners. HEALTH study locations include the Delta region plus the six ARS Human Nutrition Research Centers located in Arkansas, California, Massachusetts, Maryland, North Dakota, and Texas. Conceptually and culturally appropriate survey tools will be constructed to assess DG adherence barriers and facilitators for African-American and Caucasian children and their caregivers of the Lower Mississippi Delta region. A pilot test will be conducted to determine the psychometric properties of the survey tools. Barriers and facilitators of DG adherence and other factors as they relate to dietary behavior and body mass index will be examined by administering the surveys to cross-sections of the Lower Mississippi Delta region's population. Utilizing social marketing principles, the research will develop a small steps approach and set of tools termed the Delta DG Small Steps Tool Kit (Delta DGSS Tool Kit) addressing only diet-specific guidelines. Research will examine data previously collected in the LMD to identify gaps in knowledge, skills, and behaviors that interfere with adhering to the DG. From these findings, a priority list of tools, techniques, and technology will be planned through an iterative process with a community advisory committee working with ARS scientists/nutritionists and Delta Obesity Prevention Research Unit (Delta OPRU) collaborators from cooperating institutions. The resulting Delta DGSS Tool Kit (e.g., menus, shopping lists, food selection tips, food preparation) will be tested for feasibility with a small group of family caregivers. A community food environment survey will be conducted to assure local availability of foods and cultural acceptability. The Delta DGSS Tool Kit will be used in an intervention to examine its effectiveness to promote DG adherence in a target group of primary food gatekeeper/caregivers and their families. The effectiveness evaluation of the small steps approach will combine anthropometric, nutritional and dietary assessment in the intervention with biological assessment for biomarkers associated with fruit/vegetable intakes and for other serum markers for chronic disease risks related to obesity, e.g., hypertension, hyperglycemia. This larger study will examine how effective the Delta DGSS Tool Kit is in promoting DG adherence and preventing obesity over time in a target group of young adult mothers who act as the primary gatekeeper for food in their children.
3. Progress Report
During FY10, the Delta OPRU continued to serve as an "umbrella" for administering the subordinate research projects certified through peer review and conducted by various cooperators. The Delta OPRU initiated a quarterly peer review oversight process of all of the research projects. This involves peers from the collaborating institutions meeting to monitor the progress of the research, provide technical assistance, and submit written reports to Delta OPRU Executive Director. In August an Annual Research Workshop provided opportunities for collaborating scientists to share their progress toward research milestones, identify problems and accomplishments, discuss additional research or needed changes, develop new collaborations, plan for data analysis coordination across sites, and develop plans for publication and dissemination of results. The ARS research project, Delta Dietary Guidelines Small Steps: Small Steps to a Healthier Delta is nearing completion of the DGSS Tool Kit, and participant recruitment for the feasibility study is underway. Additionally, the Delta OPRU completed data collection for the USDA Healthy Eating and Lifestyle for Total Health (4 child/4 adults) group sessions with 58 participants and for an ancillary study of rural European Americans and African Americans (33 child/31 adult) group sessions with 392 participants. This study will provide data on a rural, at-risk population in the Delta to determine if differences in barriers and facilitators to Dietary Guidelines adherence exist between rural and urban samples collected by other HEALTH investigators. For the past three years, Delta OPRU has been conducting obesity prevention research with children ages 6 to 14 participating in an Arkansas summer day camp. This was continued during FY10 with the addition of genetic data being collected as part of the Delta Obesity Prevention and Vitamin study, an ongoing collaboration with the FDA, National Center for Toxicological Research. Approximately 200 children and adults have participated. Manuscripts are in development related to improvements in Healthy Eating Index scores of participant children over the 4-year period and relating the food and nutrient changes to blood vitamin levels.
Pawlak, R., Brown, D., Meyer, M.K., Connell, C., Yadrick, K., Johnson, J.T., Blackwell, A. 2008. Theory of planned behavior and multivitamin supplement use in Caucasian college females. Journal of Primary Prevention. 29(1):57-71.