Location: Office of The Area Director
2017 Annual Report
Objectives
1. Determine the effects of a diet and activity enhanced Maternal, Infant, and Early Childhood Home Visiting program on weight and health related outcomes in mothers and their infants.
2. Determine associations between dietary patterns (identified using variant statistical and epidemiologic approaches) and health indicators in children using the most recent NHANES datasets.
Approach
1. The Delta Healthy Sprouts Project is an 18-month, randomized, controlled comparative effectiveness trial. Participants are randomly assigned to 1 of 2 treatment arms (75 participants per arm) – Parents as Teachers (PaT) or Parents as Teachers Enhanced (PaTE). All participants receive monthly PaT lessons and materials. Only participants in the experimental arm receive PaTE supplemental nutrition and physical activity lessons and materials. The control arm utilizes the PaT curriculum which is a nationally recognized, evidence based MIECHV program that includes one-on-one home visits, monthly group meetings, developmental screenings, and resource networks for families. Through these activities, PaT seeks to increase parental knowledge of child development, improve parenting practices, provide early detection of developmental delays, prevent child abuse, and increase school readiness. PaTE, delivered to experimental participants, builds on PaT by adding culturally tailored, maternal weight management and early childhood obesity prevention components. These components include healthy weight gain during pregnancy, nutrition and physical activity in the gestational and postnatal periods, breastfeeding, appropriate introduction of solid foods, and parental modeling of positive nutrition and physical activity behaviors. The interventions are delivered in the home to women beginning early in their second trimester of pregnancy by community based, trained Parent Educators.
2. Dietary patterns will be determined for 2-18 year old U.S. children using the 2 most recent cycles of NHANES datasets with available dietary data. Analyses will be conducted separately by gender, age group (2-5, 6-11, and 12-18 years), race/ethnicity, and poverty income ratio (PIR) given sufficient sample sizes. The first dietary pattern identification method is based upon existing recommended dietary guidelines and current knowledge. The Health Eating Index-2010 (HEI-2010) ranks individuals in terms of compliance with the 2010 Dietary Guidelines for Americans. Total HEI-2010 scores range from 0-100 and are computed by summing scores for 12 components including: total fruit; whole fruit; total vegetables, greens and beans; whole grains; dairy; total protein foods; seafood and plant proteins; fatty acids; refined grains; sodium; and empty calories. For the first 9 components, higher intakes result in higher scores (healthier diet). For the last 3 components, lower intakes (more beneficial) result in higher scores. Latent class analysis (LCA), the second dietary pattern identification method, derives empirical dietary patterns based on current study data. Similar to cluster analysis, LCA partitions data into groups so that observations (children) within a group are as similar as possible to each other (foods consumed) and as dissimilar as possible to the observations in other groups. Differing from cluster analysis, LCA does not absolutely assign observations to groups, but assigns a probability of group membership. Associations between identified dietary pattern scores, excess adiposity, physical activity, and sedentary behavior will be determined.
Progress Report
Progress was made on the two objectives, both of which fall under National Program 107, Prevention of Obesity and Obesity-Related Diseases. Under Objective 1, implementation and data collection for the Delta Healthy Sprouts Project was completed in collaboration with researchers at Delta Health Alliance, the University of Illinois at Chicago, and the University of Central Arkansas. Delta Healthy Sprouts was an 18-month, randomized, controlled, comparative trial testing the impact of two Maternal, Infant, and Early Childhood Home Visiting programs on weight status, dietary intake, and health behaviors of 82 primarily African American mothers and their infants residing in the rural Lower Mississippi Delta. The control arm, Parents as Teachers, is an evidence-based approach to increase parental knowledge of child development and improve parenting practices. The experimental arm, Parents as Teachers Enhanced, built upon the Parents as Teachers curriculum by including nutrition and physical activity components designed for the gestational and postnatal periods. Analyses of the postnatal period maternal data are complete, while analyses of the infant data are on-going. These efforts have resulted in 5 published papers in peer-reviewed journals, 3 manuscripts submitted for publication to peer-reviewed journals, and 1 abstract presented at a national conference.
Under Objective 1, two ancillary studies to the Delta Healthy Sprouts Project were designed and conducted in collaboration with researchers at Delta Health Alliance and the University of Central Arkansas. The first study, Delta Food Outlets, was designed to measure the local food environments (grocery stores, convenience stores, and restaurants) of Delta Healthy Sprouts participants and explore associations between food outlet scores (based on availability of healthy foods) and participants’ diet quality. Survey selection and creation in electronic form, data collector training, study implementation, and data collection are complete. Data analysis is on-going. The second study, Delta Neighborhood Physical Activity, was designed to assess environment features and amenities (e.g., parks and playgrounds), town characteristics, and community programs and policies that promote physical activity in rural communities. Survey selection and creation in electronic form, data collector training, and study implementation are complete. Additionally, assessments of towns, parks, and playgrounds are complete. Remote mapping and measurement of neighborhood street segments (data collection) is on-going. These efforts have resulted in 1 abstract presented at a national conference.
Under Objective 1, a pilot study assessing the feasibility and acceptability of an online nutrition education program for weight loss in the federal workplace was conducted. Study design, implementation, data collection, and data analysis are complete. These efforts have resulted in 1 manuscript submitted for publication to a peer-reviewed journal.
Under Objective 1, a longitudinal study assessing the nutritional knowledge, fruit and vegetable preference and intake, and psychometric measures related to healthy behaviors of school children, their parents, and their teachers was implemented in Arkansas public schools with school garden curriculums. Baseline data was collected from 813 school children, 198 parents, and 131 teachers/school staff in the fall of 2016. Follow-up data was collected from 635 school children, 201 parents, and 111 teachers/school staff in the spring of 2017. Additionally, complete (baseline and follow-up) biometric data was collected from 48 students. Three abstracts have been accepted for presentation at national conferences.
Under Objective 1, electronic surveys were designed to collect data from producers and consumers of Farmers Market products. The producer surveys have been administered and preliminary data analysis is complete along with analysis of previously collected pesticide data from study farms. This work is in support of an FDA Office of Applied Research and Safety Assessment (OARSA) consortium based on the Healthy Affordable Renewable Variety: Enabling Sustainable Trade (HARVEST) Initiative.
Under Objective 2, a dataset of children 2-18 years of age from the 2 most recent and complete National Health and Nutrition Examination Survey was created and descriptive analyses conducted. Additionally, diet quality scores were computed and associated with overweight/obesity, physical activity, and sedentary behaviors in this nationally representative sample of children.
Accomplishments
1. Demonstrated feasibility, acceptability, and effectiveness of workplace nutrition education intervention. The annual productive costs of obesity-related absenteeism range between $3.38 billion and $6.38 billion (between $79 and $132 per obese individual) in the United States. Given the work costs associated with obesity, employers have a beneficial interest in improving and maintaining the health of their employees. However, privacy concerns may prevent some employees from participating in their workplace wellness programs. ARS researchers in Stoneville, Mississippi and Fayetteville, Arkansas, designed and implemented a pilot, 12-week, online nutrition for weight loss program (administered by an outside company) in two ARS worksites in Arkansas. Study results indicated that providing an online nutrition intervention in the federal workplace was feasible and acceptable to employees as evidenced by the high retention rate, utilization of program components, participant satisfaction ratings concerning component usefulness for healthful eating, and participant’s willingness to provide body composition measures. Additionally, the intervention was associated with health improvements, most notably reductions in weight, percent body fat, and visceral fat level.
2. Demonstrated increase in breastfeeding knowledge but not initiation or duration of breastfeeding in Lower Mississippi Delta women. Despite the benefits of breastfeeding for both infant and mother, rates in the United States remain below Healthy People 2020 breastfeeding objectives with rates notably lower in the southeastern and rural areas of the United States. ARS researchers in Stoneville, Mississippi conducted a longitudinal analysis of the Delta Healthy Sprouts participants’ breastfeeding intent, knowledge and beliefs measured at gestational months 4 (study enrollment) and gestational month 9 (just prior to giving birth), and breastfeeding behaviors (initiation and duration). Results indicated that breastfeeding knowledge scores increased significantly from baseline to the late gestational period and breastfeeding belief scores were significantly higher across time for participants who initiated breastfeeding as compared to those who did not breastfeed. Only 39% of participants initiated breastfeeding and only one (out of 54) participants breastfed for at least 6 months. These findings suggest that increasing knowledge about and addressing barriers for breastfeeding were insufficient to empower rural, Southern, primarily African American mothers to initiate or continue breastfeeding their infants. Improving breastfeeding outcomes for all socioeconomic groups will require consistent, engaging, culturally relevant education that positively influences beliefs as well as social and environmental supports that make breastfeeding the more accepted, convenient, and economical choice for infant feeding.
Review Publications
Welke, L., Koenig, M.D., Thomson, J.L., Nemeth, E., White-Traut, R., Mcfarlin, B.L., Giurgescu, C., Engeland, C., Kominiarek, M., Tussing-Humphreys, L. 2017. Iron metabolism in African American women in the second and third trimesters of high-risk pregnancies. Journal of Obstetric Gynecologic and Neonatal Nursing. 46:148-158. doi: http://dx.doi.org/10.1016/j.jogn.2016.06.013.
Thomson, J.L., Tussing-Humphreys, L.M., Goodman, M.H., Olender, S.E. 2016. Physical activity changes during pregnancy in a comparative impact trial. American Journal of Health Behavior. 40(6):685-696.
Goodman, M.H., Thomson, J.L., Tussing-Humphreys, L.M. 2017. Lessons learned from the implementation of the Delta Healthy Sprouts comparative effectiveness trial. SAGE Research Methods. doi:10.4135/9781526424006.
Thomson, J.L., Tussing-Humphreys, L.M., Goodman, M.H., Landry, A.S., Olender, S.E. 2017. Low rate of initiation and short duration of breastfeeding in a maternal and infant home visiting project targeting rural, Southern, African American women. International Breastfeeding Journal. 12:15. doi:10.1186/s13006-017-0108-y.
Thomson, J.L., Tussing-Humphreys, L.M., Goodman, M.H., Olender, S. 2016. Gestational weight gain: results from the Delta Healthy Sprouts comparative impact trial. Journal of Pregnancy. doi.org/10.1155/2016/5703607.
Tussing-Humphreys, L.M., Thomson, J.L., Goodman, M.H., Olender, S. 2016. Maternal diet quality and nutrient intake in the gestational period: results from the Delta Healthy Sprouts comparative impact trial. Maternal Health, Neonatology, and Perinatology. 2:8. https://doi.org/10.1186/s40748-016-0036-7.
