Item No. 1 of 1

INVESTIGATOR: White, J. M.

PERFORMING INSTITUTION:
PRAIRIE VIEW A&M UNIVERSITY
P.O. Box 519, MS 2001
PRAIRIE VIEW, TEXAS 77446

BUILDING CAPACITY WITHIN EXTENSION TO ENHANCE NUTRITION AND PHYSICAL ACTIVITY PROGRAM DELIVERY AMONG UNDERSERVED POPULATION/COMMUNITY

NON-TECHNICAL SUMMARY: Obesity is a serious public health problem. Prevalence of obesity and diabetes are higher among low-income minority populations compared to Whites. Because overweight children are likely to remain overweight as adults, primary prevention for both children and adults is of critical importance. The 1890 land-grant institution Extension programs provide food and nutrition education to limited-resource families in rural and urban areas via the Expanded Food and Nutrition Education Program (EFNEP). These programs are existing channels that reach low-income minority individuals, who are at a higher risk of obesity. Previous Youth EFNEP studies have shown a significant impact on youth's nutrition knowledge but mixed results on their dietary behaviors; however, these programs targeted youth only. Because parents are the gatekeepers for foods available to their children, it is important to reach parents with messages on nutrition and physical activity (PA) behaviors. However, there are other influences on youth nutrition and PA behaviors, particularly within the social systems network in which low income families exist and function. In particular, it is unknown whether social systems network, composed of family and close friends, offer positive or negative support for youth to provide a healthy home food and PA environment. The goal of the proposed project is to enhance the current nutrition and PA curriculum for youth delivered via the 1890's Extension Youth EFNEP using the social systems network approach with social media, for obesity prevention. The CBG Program Priority Area is a) Human health, obesity as it relates to nutrition, and human sciences.

OBJECTIVES: The overall goal of the proposed study is to build capacity within PVAMU's Co-operative Extension to enhance the current nutrition and PA program for youth delivered via the 1890's youth EFNEP for obesity prevention. The goal is consistent with the USDA goal of improving the nation's nutrition and health by promoting the development of healthy dietary and PA habits in children. The proposed study will be a collaborative initiative between 1890's Cooperative Extension Program at the Prairie View A&M University (PVAMU) in Texas and researchers at the USDA/ARS Children's Nutrition Research Center - Baylor College of Medicine (CNRC-BCM). The study will include all three functions of the agricultural knowledge system (i.e., extension, research, and education). The EFNEP Nutrition Education Associates (NEA's) will provide education programs for a minimum of six weeks teaching youth how to choose healthy behaviors. During these workshops they will learn how to: replace sweetened drinks with low-fat milk and water, play actively 60 minutes a day, consume more fruits and vegetables, eat fewer high-fat and high-sugar foods and more nutrient-rich and high fiber foods, eat only as often and as much as needed to satisfy hunger, limit screen time to two hours or less a day and promote healthy behaviors.

APPROACH: Evaluation Plans:Data collectionMeasurements will be done at baseline and post-test (Table 3). Data to be collected include demographics, diet and PA behaviors, diet and PA mediating variables, anthropometrics, and process data. All data collection materials will be available in both English and Spanish. Data collection will be conducted in person and over the telephone.Diet and PA behaviors:The School Physical Activity and Nutrition (SPAN) questionnaire will be used to assess food choice behaviors, food selection skills, weight perceptions and practices, nutrition knowledge, attitudes about food and eating, and PA behaviors.Parents will report their dietary and PA behaviors using the nutrition and PA modules from the Behavioral Risk Factor Surveillance System (BRFSS) and the food behavior checklist for limited resource audience.In addition, the participating parent-child dyads will also complete dietary recalls to obtain meal specific dietary intake data which cannot be obtained by SPAN/BRFSS. These will be performed by trained bilingual research assistants (for Spanish-speaking clients). The recalls will be entered into ASA2461, a freely available, validated web-based tool that enables automated self-administered 24-hour recalls.61,62The recalls will be analyzed for nutrients and food groups.Mediating variables:These will be measured using a survey instrument. Child survey instrument will include questionnaires on knowledge from SPAN53-55, asking and shopping self-efficacy63, eating healthy self-efficacy63, PA self-efficacy64, and activity support65. Parent survey instrument will include demographics, USDA's household food security questionnaire66, questionnaires on diet and health knowledge147,148, self-efficacy to help family eat a healthy diet45, purchasing social support46, activity support67, family barriers to healthy eating45, home food availability149,151, home food preparation equipment inventory, menu planning and grocery shopping practices45, food preparation practices151,152, and PA environment.68 The completion of data collection activities at each measurement point will take about 30 minutes for children and about 45 minutes for parents.Anthropometric measurements:Body mass index (BMI: Weight in kg/height in m2) is a secondary outcome variable for this study. Youth participants' heights and weights will be measured during each of the measurement points. Height will be measured to the nearest 0.1 cm twice using a stadiometer and the mean of the two recordings calculated. Body weight will be measured using a calibrated scale. BMI will then be computed.70Parents will self-report their height and weight for BMI computation.Data Analysis:The hypotheses are associated with testing the intervention effects with respect to behavioral outcomes. We hypothesize that the intervention will result in increased water, F, V, whole grains, PA, and weight maintenance or loss, increased healthy food purchases and food availability, decreased unhealthy food purchases, and increased mediational behaviors.Outcome evaluation: Analysis of Covariance will assess the intervention effects on dietary behaviors, PA, psychosocial variables and weight status. Mediation effects will be evaluated using longitudinal mediation models. The independent variable is group membership (intervention/control), the mediators are parental self-efficacy, parental modeling, and home barriers, and the outcome variables are fruit, vegetable, water, SSB, and PA. A range of fit statistics, based on Hu and Bentler's criteria71, will be used to assess model fit.Process evaluation:Process evaluation components to be measured during the intervention implementation are maintenance, monitoring, context, resource adequacy, program implementation (dose/attendance - fidelity X extent), reach (penetration), barriers, exposure (receptivity), initial and continued use (activity and habituation), and contamination.72 These data will be collected using objective observations with pre-printed forms and checklists.The study utilizes mixed methods qualitative and quantitate data collection.Recruitment for formative research:A total of 30 children and one of their parents will be recruited from the Youth EFNEP classes. Parental informed consent and child assent for the child and parent informed consent will be obtained. A packet will be sent home to the parents with the consent form and screener, and the parents will be asked to send back the completed documents with the child to the Youth EFNEP class. All participants will receive demonstration food items to prepare with their families for participation.Formative research with youth EFNEP participants to explore their barriers and facilitators for healthy eating and PA:Children will be interviewed in-person by Extension staff to explore the barriers and facilitators to healthful eating and PA. Questions will try to determine protective factors that promote healthy eating and PA behaviors associated with obesity risk, as well as the barriers: perceived risk, beliefs and knowledge about reducing obesity risk and prevention practices, motivation needed to reduce obesity risk, potential family conflicts that might arise from talking about appropriate eating and PA behaviors, cultural beliefs, and ways they feel they can influence family's healthy food and PA environment and behavior. Interviews will be digitally recorded and coded by ID for confidentiality. At the end, the interviewer will digitally record impressions, unusual events, and nonverbal behaviors that may have impacted data quality and/or accuracy. Digital recordings, including interviewer notes, will be transcribed verbatim.Interviews will be coded used a modified version of focused coding and grounded theory methods.Formative research with parents to identify feasible and acceptable strategies and messages:Individual phone interviews will be conducted with 30 parents to obtain their perspective on feasible and acceptable strategies and messages to enhance the current Youth EFNEP curriculum and include a family component to reach out to the families with health messages. All participating parents will receive a grocery bag of food demonstration items to prepare with their family. In case the parent is not able to do a phone interview, trained Extension staff will conduct the interview in person. Cultural sensitivity issues for messages and strategies will be addressed. Program materials from a previous study conducted by the Drs. Thompson and Dave with low-income clients37,38will be used as the basis for discussion on the content of the intervention. Interviews will be conducted and analyzed using the procedure described in interviews.Development of intervention messages and strategiesThis will include:1. Message and intervention developmentTheory-based content3. Mode of intervention delivery4. Intervention messages/materials pre-testingPilot testing the enhanced youth EFNEP curriculum.The purpose is to test the enhanced curriculum material, and procedures for implementation, staff training, recruitment, and data collection.

PROGRESS: 2020/03 TO 2020/10
Target Audience:The target audience for this project includes parents and youth who have been a part of the 8-week education programs conducted by NEA's in Harris, Fort Bend and Starr Counties. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?All NEAs were trained to conduct data collection using standardized protocols for anthropometrics, other survey data and individual interviews and focus groups. How have the results been disseminated to communities of interest?The data from the formative research is being written to be published in a peer reviewed journal and possibly presented at a conference either virtually or in person. What do you plan to do during the next reporting period to accomplish the goals?NEAs were trained to code and analyze interview scripts. Subsequently, the results from the interviews will help design and deliver the social media intervention. Data has been entered and analyzed. Currently, reports are being written and articles are being prepared for submission to journals.

IMPACT: 2020/03 TO 2020/10
What was accomplished under these goals? A training protocol and manual were developed for training the NEAs to conduct standardized data collection, including anthropometrics, other survey data and individual interviews/focus groups with the children and parents. All NEAs involved with the Youth EFNEP attended the trainings. Subsequently, practice sessions were held for the NEAs to ensure that all measurements were being conducted with maximum accuracy. For the formative research, the NEAs conducted the six week workshops with the participants, followed by conducting interviews and other measurements to obtain their feedback about the program and how social media can be used to deliver the program. The interview data have been transcribed and translated (for interviews that were conducted in Spanish).

PUBLICATIONS (not previously reported): 2020/03 TO 2020/10
No publications reported this period.