2007 Annual Report 1a.Objectives (from AD-416) Design, implement, and evaluate nutrition intervention research strategies in three rural communities in the Lower Mississippi Delta (in Arkansas, Louisiana, and Mississippi) using a community-based participatory research approach. Develop, implement, and evaluate culturally appropriate and sustainable community interventions, based upon the 2005 U.S. Dietary Guidelines, for obesity prevention and health promotion. Interventions should include both dietary and physical activity strategies. 1b.Approach (from AD-416) Utilize a multi-site (six universities, cooperative extension, local communities, and ARS), multi-disciplinary consortium; test intervention strategies on nutritionally responsive health problems and their causes that have been identified through repeated measures of dietary intake and selected biochemical and anthropometric measures. Evaluate the relationship of community food security to household food security measures; develop sustainable leadership in rural communities for nutrition intervention progression; develop capacity and resources within the rural communities that will expedite participatory research and sustainability of successful nutrition interventions. Monitor the environmental, behavioral, and nutritional risk factors specific to the Lower Mississippi Delta region over time; design, implement, and evaluate nutrition interventions in a collaborative effort within the region; collaborate with community residents, agencies/institutions in the Lower Mississippi Delta for recruitment, training, and monitoring of intervention research to determine sustainability; select a cohort of households to follow after interventions to assess success and sustainability over time; Initiate process of adapting successful nutrition intervention strategies to other rural communities. 3.Progress Report Three thesis papers have been produced by graduate students that are employed by ARS or are supported by ARS through a specific cooperative agreement. (PhD-University of Southern Mississippi) Ndirangu, M. 2005. Evaluating the effectiveness of the Delta Nutrition Intervention Research Initiative (NIRI) community-academia coalitions as perceived by community partners [thesis]. University of Southern Mississippi. 350 p. Powers, A. 2007. A comprehensive evaluation of a community based participatory research intervention – Fit for Life Steps [thesis]. University of Southern Mississippi. 350 p. (Masters-ARS Employee) Lovera, D. 2006. Duration of breastfeeding associated with the Breastfeeding Peer Support Program for Husbands and Fathers of Brownsville, Texas WIC participants [thesis]. University of Texas Medical Center. 40 p. A doctoral student supported by Delta NIRI at Tufts University has developed three manuscripts in lieu of submitting a dissertation: Published: Talegawkar, S., Johnson, E., Carithers, T., Taylor JR., H., Bogle, M. 2007. Tocopherol intake and status in the Diet and Physical Activity Sub-Study of the Jackson Heart Study. Journal of Nutrition. 137:2297-2303. Under Review: Talegawkar, S., Johnson, E., Carithers, T., Herman, T., Bogle, M., Tucker, K. 2007. Dietary patterns are associated with antioxidant biomarkers in the Diet and Physical Activity Sub-Study of the Jackson Heart Study. American Journal of Clinical Nutrition. Talegawkar, S., Johnson, E., Carithers, T., Taylor Jr., H., Bogle, M., Tucker, K. 2007. Carotenoid intakes, assessed by food frequency questionnaires are associated with serum carotenoid concentrations in the Jackson Heart Study Validation of the Jackson Heart Study Adult Food Frequency Questionnaire. Public Health Nutrition. The research reflected in these citations has contributed to the progress of the community-based participatory research in the Lower Mississippi Delta and the field of science. 4.Accomplishments Community Walking Intervention: The lower Delta regions of AR, LA, and MS are primarily rural communities (composed of mostly minorities) with high rates of poverty, low educational attainment, obesity, hypertension, and other nutrition-related chronic diseases. Intervention strategies to prevent obesity are difficult to implement in these areas because of limited accessibility (distance), limited financial resources, limited access to facilities, and reluctance of communities to participate in research. The Lower Mississippi Delta NIRI, Little Rock, AR, worked in conjunction with multiple communities in the planning, implementation, data collection and evaluation for a 6-month nutrition and physical activity intervention for adults in Arkansas and Mississippi. Results included significant health improvements in waist circumference, blood pressure, and HDL-C with participants increasing minutes walked per day. Two manuscripts (one published and one in press) highlight the importance of this research for other rural communities planning nutrition/physical activity interventions that are using physical activity as a tool for preventing obesity or establishing a healthier lifestyle. Community-based participatory methods can be applied in the rural Delta region, and participants are committed to health promoting interventions. More importantly, interventions like these serve as possible solutions to alleviate the escalating number of healthcare cases in the US Delta region that are associated with nutrition-related chronic diseases. (NP 107, Human Nutrition Action Plan, Component 7: Health Promoting Intervention Strategies for Targeted Populations: ARS Strategic Plan Objective 4.l: Promote Healthier Individual Food Choices and Lifestyles and Prevent Obesity and Performance Measure 4.1.1: Execute and report on two completed Delta NIRI projects) Food Supply Adequacy in the Lower Mississippi Delta: The food choices individuals make determine the quality of their diet, but for many US Delta residents, many times these choices are directly impacted by poverty and food insecurity, as well as access to food stores that maintain adequate supply and variety. Lower Mississippi Delta NIRI researchers developed and tested a regional food store survey to determine food availability and quality in supermarkets, small/medium stores, and convenience stores in the lower Mississippi Delta region of AR, LA, and MS. Our research team discovered that supermarkets carried a large percentage of the food items surveyed and that the overall food quality was better; however, the number of supermarkets in this rural region was few and distant to many communities. Community residents with limited transportation are likely to experience limited food supply, as small/medium and convenience stores carried few of the USDA Thrifty Food Plan (TFP) items. The impact of this research is that in order for scientists and communities to perform nutrition interventions to improve food quality in the rural Delta region, they will have to partner with small/medium food stores, investigate community gardening or food co-ops, or develop other environmental issues to impact resident's food choices and diet quality. (NP 107, Human Nutrition Action Plan, Component 7: Health Promoting Intervention Strategies for Targeted Populations: ARS Strategic Plan Objective 4.l: Promote Healthier Individual Food Choices and Lifestyles and Prevent Obesity and Performance Measure 4.1.1: Execute and report on two completed Delta NIRI projects) Diet Quality in the Lower Mississippi Delta: Scientific evidence regarding the quality of the diet in the Lower Mississippi Delta (LMD) is sparse. Designing nutrition interventions that improve the food choices and assist in preventing obesity requires information about current status of the diet and food choices. The Lower Mississippi Delta NIRI FOODS 2000 study provided the most recent data relative to what is eaten in the Delta region of AR, LA, and MS. Two related Lower Mississippi Delta NIRI research studies utilized this data to assess the diet quality by applying the USDA Healthy Eating Index (HEI) to identify potential interventions and to determine the effect of food insecurity on diet quality. None of the demographic groups in the LMD met the desired goals of healthy eating as measured by HEI scores of 80 or above. As defined by the percentage of Dietary Reference Intakes (DRI), food-secure individuals achieved higher levels of nutrients than food-insecure adults. The scientific importance of these studies is that nutrition intervention strategies in the LMD region must focus on nutritious food choices that include fruits and vegetables, strategies for low income and food-insecure families, and issues related to sustainability. Other scientists can use this information in working with other rural communities in order to combat obesity and other nutrition-related chronic diseases. Two manuscripts have been written for peer reviewed journals (one published and one in press). (NP 107, Human Nutrition Action Plan, Component 3: Nutrition Monitoring and Component 7: Health Promoting Intervention Strategies for Targeted Populations: ARS Strategic Plan Objective 4.l: Promote Healthier Individual Food Choices and Lifestyles and Prevent Obesity and Performance Measure 4.1.1: Execute and report on two completed Delta NIRI projects) Willingness to Try New Foods (WillTry) Studies: Community members and university partners in the Lower Mississippi Delta NIRI recognized that the unwillingness of young people to try new foods is a major factor in their hesitance in consuming nutritious food. Since the Lower Mississippi Delta NIRI study FOODS 2000 determined that children’s intake of fruits and vegetables in the Delta was less than recommended, our research team developed and tested a WillTry Questionnaire as a means of assessing the level of residents' willingness to try new foods in the Delta. WillTry assessed the personal level at which children and parents are willing to try new foods, if the child was a picky eater or not, and whether the parent and child considered themselves as healthy eaters. A healthy fruit and vegetable snack feeding trial indicated that children were willing to taste new foods in a group setting beyond what was initially reported in their interviews. Researchers discovered that children frequently asked for additional servings of the healthy snacks, further indicating their willingness to accept fruits and vegetables as snacks. The instrument was well received when presented at the Fifth International Conference on Dietary Assessment, and this questionnaire will be used in a larger multi-component obesity prevention study. (NP 107, Human Nutrition Action Plan, Component 7: Health Promoting Intervention Strategies for Targeted Populations: ARS Strategic Plan Objective 4.l: Promote Healthier Individual Food Choices and Lifestyles and Prevent Obesity and Performance Measure 4.1.1: Execute and report on two completed Delta NIRI projects) School Kids Access to Treats to Eat (SKATE): Rates of childhood obesity continue to be higher in the Delta region, especially in Mississippi, than in the rest of the US, with poor food choices being viewed as contributing to the problem. Researchers at the Lower Mississippi Delta NIRI completed SKATE (School Kids Access to Treats to Eat), a school-based intervention with over 200 participants, to promote consumption of fruits and vegetables. Three areas were assessed: the Willingness to Try New Foods (WillTry), Food Recognition and Food Experience Checklist, and snack feeding three days a week for six weeks. Our results indicate that parents do not accurately perceive their children’s willingness to try new foods, children are more willing to taste new foods than initially reported, and food recognition, experience, and nutrition education relate to actual consumption. A major result of this study was establishing the feasibility of incorporating fruit and vegetable snacks and nutrition activities into regular school days in a low income area rural elementary school. This school is eager to continue and expand this study to other grade levels. SKATE demonstrates the value of bringing community members, school administrators, teachers, and researchers as full partners in the research process. (NP 107, Human Nutrition Action Plan, Component 7: Health Promoting Intervention Strategies for Targeted Populations: ARS Strategic Plan Objective 4.l: Promote Healthier Individual Food Choices and Lifestyles and Prevent Obesity and Performance Measure 4.1.1: Execute and report on two completed Delta NIRI projects) Marvell NIRI Youth Obesity Prevention Intervention: The prevalence of obesity in children and youth in the US continues to increase, and the obesity rates in children in the Delta are higher than the national average. The Marvell NIRI (AR), a research site of the Lower Mississippi Delta NIRI, identified three major health problems to address in their community: intake of unhealthy foods, lack of nutrition knowledge, and lack of physical activity. Lower Mississippi Delta NIRI researchers utilized a youth Summer Day Camp pilot project to address all three questions in a multi-component obesity prevention intervention. The program included nutrition education, the SPARK physical activity intervention, and "WillTry" which exposed participants to new healthy snacks, including fruits and vegetables. Seventy-one participants completed the program. It is anticipated that the children will make some positive changes by increasing consumption of fruits and vegetables and healthy snacks and increasing physical activity. (NP 107, Human Nutrition Action Plan, Component 7: Health Promoting Intervention Strategies for Targeted Populations: ARS Strategic Plan Objective 4.l: Promote Healthier Individual Food Choices and Lifestyles and Prevent Obesity and Performance Measure 4.1.1: Execute and report on two completed Delta NIRI projects) National Symposia for Scientific and Lay Communities: A lack of good theoretical models exists for sustainable nutrition interventions in rural communities; as a result the Lower Mississippi Delta NIRI has identified community-based participatory research methods (CBPR) and comprehensive participatory planning and evaluation (CPPE) as concepts and theories to be tested in the Lower Mississippi Delta for nutrition intervention research. A series of regional, national, and international symposia were planned and executed to provide other scientists and community residents an opportunity to learn about the Lower Mississippi Delta NIRI's successes and challenges. ARS and the Lower Mississippi Delta NIRI co-sponsored a national symposium for historically black colleges and universities on CBPR offered through Tougaloo College, Jackson, MS, and led a workshop on CPPE at this summer institute. A workshop entitled Community Nutrition Intervention Development Using CPPE was presented at the national meeting of the Society for Nutrition Education in Chicago, IL. International symposia on CBPR/CPPE and nutrition intervention strategies were developed and presented at the 10th Anniversary International Conference of Community-Campus Partnerships for Health (CCPH), Toronto, Canada, and the annual meeting of the International Society for Behavioral Nutrition and Physical Activity in Oslo, Norway. The importance of these workshops and presentations is that other scientists and rural communities can use the techniques and lessons learned in the Lower Mississippi Delta to improve nutrition and health. (NP 107, Human Nutrition Action Plan, Component 7: Health Promoting Intervention Strategies for Targeted Populations: ARS Strategic Plan Objective 4.l: Promote Healthier Individual Food Choices and Lifestyles and Prevent Obesity and Performance Measure 4.1.1: Execute and report on two completed Delta NIRI projects) A Mapping Approach to Nutrition Interventions: Rural communities and university researchers need techniques and methods related to community-based research to be able to successfully implement and evaluate nutrition interventions. The Lower Mississippi Delta NIRI supported a community-based research workshop in Houston, TX, that brought together numerous academic institutions and community partners that represent African American, Mexican American, and Native American populations from three different rural regions of the US. Participants were provided state of the art technical assistance on community-based research, intervention mapping approaches for health promotion, and plans for an intervention in their home communities. Each team left the workshop with new skills and an action plan of short- and long-term goals to implement in their communities. The impact of this workshop is evident in the following: one group has written a grant to fund their intervention; another group had greater success in recruiting participants for their interventions; and still another group has been strengthened to continue to work together for environmental causes to improve physical activity and access to quality food through gardening. Moreover, this demonstrates that community-based research techniques and methods when utilized have a beneficial impact in participant's communities and that these workshops are desired by individuals involved in the fields of rural/public/community health. (NP 107, Human Nutrition Action Plan, Component 7: Health Promoting Intervention Strategies for Targeted Populations: ARS Strategic Plan Objective 4.l: Promote Healthier Individual Food Choices and Lifestyles and Prevent Obesity and Performance Measure 4.1.1: Execute and report on two completed Delta NIRI projects) 6.Technology Transfer Number of non-peer reviewed presentations and proceedings 41 Number of newspaper articles and other presentations for non-science audiences 5 Review Publications Stuff, J.E., Casey, P.H., Connell, C., Champagne, C.M., Gossett, J.M., Harsha, D., McCabe Sellers, B.J., Robbins, J.M., Simpson, P.M., Szeto, K.L., Weber, J.L., Bogle, M.L. 2007. Household food insecurity and obesity, chronic disease, and chronic disease risk factors. Journal of Hunger and Environmental Nutrition. 1(2):43-62. Connell, C.L., Yadrick, M.K., Simpson, P., Gossett, J., McGee, B., Bogle, M.L. 2007. Food supply adequacy in the lower Mississippi Delta. Journal of Nutrition Education and Behavior. 39(2):77-83. Casey, P.H., Simpson, P.M., Gossett, J.M., Bogle, M.L., Champagne, C.M., Connell, C., Harsha, D., McCabe Sellers, B.J., Robbins, J.M., Stuff, J.E., Weber, J. 2006. The association of child and household food insecurity with childhood overweight status. Pediatrics. 118(5):e1406-e1413. Struempler, B.J., Raby, A. 2005. Pizza please: An interactive nutrition evaluation for second and third grade students. Journal of Nutrition Education and Behavior. 37(2):92-95. Ndirangu, M., Perkins, H., Yadrick, K., West, J.R., Bogle, M.L., Avis-Williams, A., Santell, R., Connell, C. 2007. Conducting needs assessment using the Comprehensive Participatory Planning and Evaluation (CPPE) mode to develop nutrition and physical activity interventions in a rural commmunity in the Mississippi Delta. Progress in Community Health Partnerships: Research, Education and Action. 1(1):41-48. Zoellner, J., Connell, C., Santell, R., Fungwe, T., Strickland, E., Avis, A., Yadrick, K., Lofton, K., Rowser, M., Powers, A., Lucas, G., Bogle, M.L. 2007. Fit for Life Steps: Results of a successful walking trail intervention in the rural Mississippi Delta. Progress in Community Health Partnerships: Research, Education and Action. 1(1):49-60. McCabe Sellers, B.J., Bowman, S.A., Stuff, J.E., Champagne, C.M., Simpson, P.M., Bogle, M.L. 2007. Assessment of the diet quality of U.S. adults in the Lower Mississippi Delta. American Journal of Clinical Nutrition. 86(3):697-706. McCabe Sellers, B.J., Chenard, C., Bogle, M.L. 2007. Meeting the needs of U.S. dietitians for food composition data. Journal of Food Composition and Analysis. doi:10.1016/j.jfca.2007.07.002. Thornton, A., McGee, B., Paeratakul, S., Mellad, K., Eubanks, G., Fomby, B., Gossett, J., Bardell, K. 2006. The Influence of socio-demographic factors on psycho-social beliefs in rural Lower Mississippi Delta residents. Race, Gender and Class. 13(1-2):154-167. Talegawkar, S.A., Johnson, E.J., Carithers, T., Taylor, H.A., Bogle, M.L., Tucker, K.L. 2007. Total a-tocopherol intakes are associated with serum a-tocopherol concentrations in African American adults. Journal of Nutrition. 137(10):2297-2303. Jo, C., Simpson, P.M., Gossett, J.M., Bogle, M.L. 2007. Regression splines with longitudinal data: SAS Survey Procedures and NHANES. SAS Global Forum 2007, April 16-19, 2007, Orlando, Florida. Paper 143-2007. Available: http://www2.sas.proceedings/forum2007/143-2007.pdf. Gossett, J.M., Simpson, P.M., Patrick, C.H., Whiteside-Mansell, L., Bradley, R., Jo, C., Bogle, M.L. 2007. Growing growth curves using PROC MIXED and PROC NLMIXED: SAS Survey Prodedures and NHANES. SAS Global Forum 2007, April 16-19, 2007, Orlando, Florida. Paper PR03-2007. Available: http://www.lexjansen.com/pharmasug/2007/pr/pr03.pdf. Harbaugh, B.L., Jordan-Welch, M., Bounds, W., Blom, L., Fisher, W., Bogle, M.L. 2007. Nurses and families rising to the challenge of overweight children. Journal of the American Academy of Nurse Practitioners. 32(3):30-35. Eck, S.M., Struempler, B., Raby, A. 2005. Once upon a yime in America: Interactive nutrition evaluation. Journal of Nutrition Education and Behavior. 37:46-47. Beattie, S., McCabe Sellers, B.J., Bogle, M.L. 2007. Food safety and bioterrorism. In: Edelstein, S., editor. Managing Food and Nutrition Services for the Culinary, Hospitality, and Nutrition Professions. Sudbury, MA:Jones and Bartlett, Inc. p. 403-427. McCabe Sellers, B.J., Bogle, M.L. 2006. The role of the United States Department of Agriculture (USDA) in public health, a handbook for developing programs and services. In: Edelstein, S., editor. Nutrition in Public Health: a Handbook for Developing Programs and Services. 2nd edition. Sudbury, MA: Jones and Bartlett Publishers. p. 267-292.