Location: Delta Obesity Prevention Research2011 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
The Delta Obesity Prevention Research Unit (Delta OPRU) is evaluating a small steps approach to the recommendations (fourteen in all) within the 2005 Dietary Guidelines for Americans. Four food groups (fruits, vegetables, grains, and low fat dairy) were chosen because previous research showed that these four food groups were not consumed in recommended amounts in the Lower Mississippi Delta (LMD). A draft Delta Dietary Guidelines Small Steps Tool Kit consisting of six modules (Eat More Fruit; Vegetables are Good; Fruits and Vegetables go Together; Add Whole Grains; Add Low Fat Milk Products; and Let's Put it All Together) was developed to assist participants to gradually improve their food intake by emphasizing one food group at a time. Draft versions of the modules were presented to individuals in the LMD in interviews to determine if they understood the modules as they were written. A LMD Community Advisory Committee (CAC) reviewed the modules for cultural appropriateness and food availability. To assist with food availability the research team conducted a Community Food Environment Survey in the area where the focus groups were located. This survey assessed the availability of foods on a basic food list in convenience stores, small grocery stores, and supermarkets. The food list was a combination of the foods commonly eaten in the LMD plus foods needed to meet the recommendations for fruits, vegetables, grains, and low fat dairy products. After analyzing all of the responses from the individual interviews, focus groups, and the CAC, the modules were revised. Community Nutrition Educators, teachers recruited from the LMD who were familiar with food preparation and food availability in the communities, were trained by the Delta OPRU Research Team on how to present the modules of the Small Steps Tool Kit in focus groups. The next phase of the study was to determine if the revised modules were feasible for LMD families to use. Mothers or caregivers with children age 6 to 14 years of age participated. Four modules (fruits, vegetables, grains, and low fat dairy products) were presented to focus groups in Arkansas, Louisiana, and Mississippi. The modules had varying numbers of tools. Comments were prioritized by the group, using the nominal group technique, from most helpful to least helpful. All of the tools in each of the modules were thought to be helpful, with the tools stressing the healthfulness of the food group receiving the highest priority scores. Data from the feasibility study are being used to revise the modules in the Toolkit in preparation for the effectiveness trial/intervention to begin in the fall of 2011.
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