Location: Office of The Area Director
2018 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
Under Objective 1, analyses concerning the comparison of maternal changes in psychosocial measures between Delta Healthy Sprouts treatment arms were completed. Analyses concerning comparisons of infant outcomes (growth trajectories, diet, activity, and sleep behaviors) between Delta Healthy Sprouts treatment arms also were completed. Interpretation of these analyses and subsequent reporting of the results were conducted in collaboration with researchers at 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.
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 the first phase of data collection are complete. To date, 14 grocery stores, 47 restaurants, and 83 convenience stores have been measured. The second phase of data collection and data analysis are 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, study implementation, and data collection are complete. In total, 12 towns, 32 parks/playgrounds, and 645 street segments were measured. Data analysis is on-going.
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 accepted for publication in a peer-reviewed journal.
Under Objective 1, a longitudinal study assessing nutritional knowledge, fruit and vegetable preference and intake, psychometric measures related to healthy behaviors, and biometric outcomes of school children was implemented in Arkansas public schools with school garden curriculums. These efforts have resulted in 1 successful thesis and 1 abstract accepted for presentation at a national conference.
Under Objective 1, 3 pilot studies were designed and conducted. The first involved a worksite wellness project; the second tested the effects of dietary supplementation on endurance and body composition; and the third explored associations between childhood obesity and body image in rural, low income school children. These efforts have resulted in 3 abstracts presented at regional meetings and 3 abstracts accepted for presentation at a national conference.
Under Objective 2, the diet quality of American children 2-18 years of age was calculated overall and by sociodemographic characteristics (age, gender, race/ethnicity, and poverty to income ratio), body composition measures (body mass index and waist circumference), physical activity and sedentary behavior, and clinical measures (blood pressure, blood glucose, and cholesterol). The analyses were conducted using the 3 most recent cycles of the National Health and Nutrition Examination Survey with dietary data (2009-2010, 2011-2012, and 2013-2014). These efforts have resulted in 1 manuscript submitted for publication to a peer-reviewed journal.
Accomplishments
1. Provision of nationally representative estimates of children’s diet quality in the United States overall and by sociodemographic characteristics. Because proper nutrition is vitally important for health, it is essential that the nutritional status of the nation’s various populations is reported on a timely basis. Tracking the diets of children may be of particular importance not only because of developmental issues, but also because of adverse conditions associated with improper dietary intake, such as prediabetes. ARS researchers at Stoneville, Mississippi, analyzed the diet quality of American children 2-18 years of age using dietary datasets from the National Health and Nutrition Examination Survey (2009-2014). Using the Healthy Eating Index, diet quality (total and component) scores were calculated overall and by age group (2-5, 6-11, and 12-18 years), gender, race/ethnicity, and family poverty to income ratio (below and at/above the poverty threshold). The total diet quality score for children overall was 55 (on a scale of 0-100). As age group increased, diet quality decreased (60 vs. 54 vs. 52). Diet quality was significantly lower for non-Hispanic black children versus Mexican American children, other Hispanic children, and children of other races (53 vs. 57, 57, and 57). Diet quality also was significantly lower for non-Hispanic white children versus Mexican American children (54 vs. 57). No differences in diet quality were apparent between boys and girls nor between poverty threshold classes. The diet quality of American children remains low overall with continued disparities across some sociodemographic populations, notably age and race/ethnicity.
Review Publications
Thomson, J.L., Tussing-Humphreys, L.M., Goodman, M.H., Landry, A.S. 2017. Enhanced curriculum intervention did not result in increased postnatal physical activity in rural, Southern, primarily African American women. American Journal of Health Promotion. 32(2):1-9.
Tussing-Humphreys, L.M., Thomson, J.L., Hemphill, N.I., Goodman, M.H., Landry, A.S. 2017. Maternal weight in the postpartum: results from the Delta Healthy Sprouts trial. Maternal Health, Neonatology, and Perinatology. 3:20. https://doi.org/10.1186/s40748-017-0058-9.
Thomson, J.L., Tussing-Humphreys, L.M., Goodman, M.H., Landry, A.S. 2018. Infant activity and sleep behaviors in a maternal and infant home visiting project among rural, Southern, African American women. Maternal Health, Neonatology, and Perinatology. 4:10. https://doi.org/10.1186/s40748-018-0078-0.
Thomson, J.L., Goodman, M.H., Tussing-Humphreys, L.M., Landry, A.S. 2018. Infant growth outcomes from birth to 12 months of age: findings from the Delta Healthy Sprouts randomized comparative impact trial. Obesity Science & Practice. 4(4):299-307. https://doi.org/10.1002/osp4.272.
