2005 Annual Report 1.What major problem or issue is being resolved and how are you resolving it (summarize project aims and objectives)? How serious is the problem? What does it matter? The Lower Mississippi Delta (LMD) area of Arkansas, Louisiana, and Mississippi is characterized by high rates of poverty, low education attainment, and food insecurity. There is a high prevalence of hypertension, diabetes, obesity, anemia, and heart disease, all of which are influenced by nutrition. We are attempting to resolve these problems through the efforts of the Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI). The Delta NIRI Consortium consists of the original partners: scientists from Alcorn State University, Alcorn State, MS (ASU); Arkansas Children's Hospital Research Institute, Little Rock, AR (ACHRI); Pennington Biomedical Research Center, Baton Rouge, LA (PBRC); Southern University and A&M College, Baton Rouge, LA (SU); The University of Arkansas at Pine Bluff, Pine Bluff, AR (UAPB); The University of Southern Mississippi, Hattiesburg, MS (USM); and the Agricultural Research Service (ARS) of USDA, Little Rock, AR. The Delta NIRI Consortium also now includes representatives from the Arkansas, Louisiana, and Mississippi Cooperative Extension Service; the College of Public Health of the University of Arkansas for Medical Sciences, Little Rock, AR; a private researcher, Jackson, MS; and members from the Delta communities of Marvell, AR; Hollandale, MS; and Franklin Parish, LA. The ARS has initiated agreements with other scientists with needed expertise for specific research requirements. For example, the Children's Nutrition Research Center (CNRC) in Houston is collaborating with a Baylor College of Medicine scientist that has nutrition epidemiology skills, and the Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston is providing expertise on the development of an original adult food frequency questionnaire. These scientists, Extension, and community members participate fully in the Delta NIRI Consortium. The Consortium is diverse in its composition: including minorities, many research disciplines (nutrition, food science, family economics, sociology, medicine, community development, community grass root, agriculture, etc.), and a variety of professionals (nutritionists, pediatricians, nurses, food scientists, sociologists, agriculture economists, etc.). This diversity is necessary because of the complexity of the food concerns, poverty, isolation, and low educational attainment in parts of the Delta region. The Delta NIRI Consortium is evaluating the nutritional health in the LMD, to identify nutritionally responsive problems, and to design and evaluate interventions using a community participatory research model. Use of this model will promote capacity-building and sustainability at the community level. Lessons learned about successful intervention approaches will be disseminated in order to facilitate implementation on a larger scale in similar areas of the United States. Rates of rural poverty and nutrition-related chronic diseases in the LMD are among the Nation's highest. Arkansas, Mississippi, and Louisiana traditionally rank at or near the bottom in health rankings of the United States and continue to worsen compared with other states. Food insecurity, adult and child obesity, and high blood pressure and diabetes among adults are higher in each of these states than for the national average. The area is underserved by food and nutrition and other health professionals, thus the burden of food-related health problems is carried by minority, low-income, and educationally disadvantaged individuals and families in the Delta communities. The presence of these problems severely limits the quality of life, productivity, and the future of this rural, at-risk population, while propelling them into the high-user category for nutrition assistance programs and high-cost health care and treatment of nutrition-related disease. The Lower Mississippi Delta Nutrition Intervention Research Initiative falls under the National Program 107 - Human Nutrition, and addresses ARS Strategic Plan performance goal 4.1.1 through developing and transferring effective nutrition intervention strategies. 2.List the milestones (indicators of progress) from your Project Plan. Year 2005: Objective 1. Develop nutrition interventions in the Lower Mississippi Delta (LMD) through community-based participatory research. Milestone a) The Community Groups and a community-based research team will be in place in three communities in AR, LA, MS. Milestone b) The research worksite will provide a neutral site in each community and enhance visibility of the Delta NIRI. Milestone c) An assessment of community resources and environmental conditions relevant to nutrition interventions will be complete. Objective 2. Design the nutrition intervention research using a Comprehensive Participatory Planning and Evaluation (CPPE) process. Milestone a) Potential interventions and strategies will be identified and evaluated. Milestone b) A research protocol for each of the selected interventions will be written. Milestone c) New and modified data collection instruments will be developed. Milestone d) Manuscripts will be completed describing the CBPR process, research worksite development, community readiness, resource assessment, and other elements of the pilot testing and preparation for interventions. Milestone e) One regional conference of scientific and lay communities will be completed. Objective 3A. Implement nutrition intervention strategies in selected LMD communities. Milestone a) Well-written research protocols for nutrition interventions in each of three communities will be finalized. Milestone b) Data collection instruments and procedures will have been pretested. Milestone c) Community and university individuals will be trained to collect data and monitor data collection. Milestone d) A detailed operational plan for the implementation process will be completed. Milestone e) Appropriate institutional review board approval for human subject's participation will be in place for each partner institution. Milestone f) Manuscripts describing pilot testing intervention strategies, data collection procedures, and training of data collectors will be completed for peer reviewed journals. Year 2006 Objective 3A. Implement nutrition intervention strategies in selected LMD communities. Milestone a) Implement nutrition intervention strategies specific to Marvell, AR, Franklin Parish, LA, and Hollandale, MS. Milestone b) Monitor data collection and intervention strategies Milestone c) Evaluate process variables associated with nutrition interventions. Milestone d) Prepare and publish manuscripts. Year 2007 Objective 3B. Evaluate nutrition intervention strategies specific to selected LMD communities. Milestone a) Evaluate nutrition intervention strategies specific to Marvell, AR, Franklin Parish, LA, and Hollandale, MS. Milestone b) Develop measures to evaluate the impact of the CBPR process on the Community Groups. Milestone c) Monitor the effects of other activities within the communities on intervention strategies. Milestone d) Utilize appropriate qualitative and quantitative statistical techniques to evaluate objectives and test hypotheses in each community. Milestone e) Community groups will participate in the analytical process. Milestone f) A data monitoring and evaluation system will be in place for continuous monitoring of data collection and quality of processes used. Milestone g) Manuscripts describing the status of interventions with regards to process and outcome variables will be completed for peer reviewed journals. Milestone h) Develop national symposia for scientific and lay communities on CBPR, CPPE, and nutrition intervention strategies for rural areas. Year 2008 Objective 4. Initiate the process of adapting the successful nutrition intervention strategies to other LMD communities. Milestone a) At least three additional communities will be targeted and recruited for community-based nutrition intervention research to duplicate the successful strategies and interventions. Milestone b) Manuscripts describing the research process and intervention outcomes will be prepared for peer reviewed journals. Milestone c) Convene national symposia for scientific and lay communities on CBPR, CPPE, and nutrition intervention strategies for rural areas. 4a.What was the single most significant accomplishment this past year? COMMUNITY-UNIVERSITY-ARS COLLABORATION WORKING The three rural communities (Marvell, AR, public school district; the city of Hollandale, MS; and Franklin Parish in LA) needed an organizational structure; policies and procedures for conducting business; information on nutrition-related problems; and intervention strategies to solve those problems. All three Community Groups are functional and collaborating in nutrition intervention strategies within their defined communities. This was accomplished by providing information and leadership on Community-Based Participatory Research (CBPR) procedures; applying the Comprehensive Participatory Planning and Evaluation model (CPPE); and by regular interaction of university and ARS scientists within the communities. Capacity was developed in each community for research techniques; Institutional Review Board (IRB) and Health Information Portability Authorization Act (HIPAA); and for data collection relative to specific nutrition intervention strategies to be implemented. Students (Valedictorian and Salutatorians, plus others) and volunteers were recruited and trained and are participating in each group. The impact of this community-university-ARS collaboration will be the ability of the communities to develop, implement, and evaluate food and nutrition interventions in the future. University scientists have learned that the Community groups have unique expertise that allowed the intervention to be implemented and be on-going. If the interventions are to be sustained in the communities, these collaborations will be in place for continuation of the joint efforts. 4b.List other significant accomplishments, if any. ALL DELTA CONFERENCE CONVENED Other scientists in the region and lay members of the three rural communities had not had an opportunity to discuss the CBPR and CPPE work outside their group. They needed to see that the models and procedures were working in other communities with similarity of objectives and some differences specific to each community. A regional conference, sponsored by the three Community Groups, Marvell, AR, Hollandale, MS, Franklin Parish, LA, and ARS was convened in Robinsonville, MS. The theme of the conference was "Collaborating Communities: Creating a Health Climate for Change". Approximately 160 scientists, lay persons, university staff and ARS personnel were in attendance for the two day program. The program included speakers from all Delta NIRI Consortium members and individuals from all three communities. Topics presented: A historical view of the Delta NIRI from the congressional view to the ARS and Community View; a successful community intervention in El Paso, TX "Que Sabrosa Vida Nutrition Initiative"; CBPR and CPPE, and what’s happening in the 3 states. Concurrent sessions were conducted on various topics from abstracts submitted from the groups. A total of 55 posters were chosen from abstracts submitted. The impact of the conference was to reinforce the community research groups in their intervention planning. Scientists learned for the first time how the CBPR and CPPE processes were successful in rural communities of the LMD; and lay community people learned how very important their expertise was to the overall project. 5.Describe the major accomplishments over the life of the project, including their predicted or actual impact. Major accomplishments over the life of the Delta NIRI are: 1) nutrition and related scientists were added to ARS and the University collaborators; 2) all partners participated in the processes of CBPR and CPPE; 3) a functional consortium of 7 universities, ARS, and cooperative extension has been developed; 4) Five major surveys to determine need and resources have been completed: a) a pilot test that determined that telephones could be used for surveys in the LMD; b) a Key Informant Survey that indicated how key leaders in the LMD ranked health and nutrition problems; c) Foods of Our Delta Study (cross-sectional survey of 36 counties) that identified what people were eating in the LMD. The extent of food insecurity and hunger, and self-reported nutrition related chronic diseases, d) a Community Resource Assessment that identified nutrition, health and physical activity resources specific to the three communities, e) a Community Readiness Survey that determined the level of readiness of each community to participate in nutrition intervention research; 5) developed a Delta NIRI Adult Food Frequency Questionnaire (Delta NIRI FFQ) from FOODS 2000; 6) established collaboration with Jackson Heart Study to validate the Delta NIRI FFQ; 7) published 27 manuscripts in peer reviewed journals, approximately 84 abstracts and presentations at National meetings and 36 International meetings; four MS Thesis and two PhD dissertations; 8) developed a collaboration with cooperative extension in AR, LA, and MS to provide the Community Coordinator for each local research worksite. The customers of the Delta NIRI are the university and cooperative extension partners, the citizens of the three rural communities (Marvell, AR, Hollandale, MS, and Franklin Parish, La), and scientists throughout ARS and the US who want to learn about CBPR and CPPE. All accomplishments made under this project are fully consistent with relevant milestones listed in the Project Plan, and with the relevant research components as defined in the National Program 107 Action Plans performance goals through developing and transferring effective nutrition intervention strategies. Accomplishments under this project contribute to the achievement of ARS Strategic Plan Goal 4, Objective 1, Performance Measure 1, in that project accomplishments contribute substantially to attainment of the Agency FY 2007 target of executing and reporting nutritional interventions. 6.What science and/or technologies have been transferred and to whom? When is the science and/or technology likely to become available to the end-user (industry, farmer, other scientists)? What are the constraints, if known, to the adoption and durability of the technology products? 1) Individuals in each of the three communities have learned the scientific process related to specific nutrition intervention strategies and how to identify and solve problems in their communities. This resulted in a grant submission by the community to NIH. 2) Instruments from Delta NIRI Key Informant Survey, FOODS of our Delta Study 2000, and the Community Readiness Survey were shared with a consortium of universities in the Texas Lower Rio Grand Valley which were used in grant submission to NIH. 7.List your most important publications in the popular press and presentations to organizations and articles written about your work. (NOTE: List your peer reviewed publications below). Bogle, M.L. 2005. Partnering to Combat Obesity. Joint Association of Extension Administrators and Association of Research Directors Conference, June 19-20, 2005, New Orleans, Louisiana. Bogle, M.D. 2005. Delta NIRI's Nutrition Intervention Emphasis on Preventing Obesity. TRIUMPH: Trends, Resources, and Inspiration for Understanding and Maintaining Physical Health. American Council for Fitness and Nutrition and National Association for Health and Fitness, March 15, 2005, Little Rock, Arkansas. Bogle, M.L. 2005. A Delta NIRI Perspective on Obesity. Seminar Series. College of Public Health, University of Arkansas for Medical Sciences, September 2005, Little Rock, Arkansas. McCabe, B.J., Hyman, E., Strickland, E., Bogle, M.L. 2004. Grandparents raising grandchildren: What are the health impacts? Women's Rural Health Conference., October 29, 2004, Hershey, Pennsylvania. McCabe-Sellers, B.J. 2004. Expanding partnerships between research and service. The Network TUFH/CCPH International Congress, October 6, 2004, Atlanta, Georgia. McCabe-Sellers, B.J. 2004. "Telling it like it is": Comprehensive assessment of rural communities for food and nutrition intervention planning. American Public Health Association Annual Meeting, November 10, 2004, Washington, DC. McCabe-Sellers, B.J. 2005. Community-based participatory research in the Lower Mississippi Delta. Robert Wood Johnson Scholars Meeting, May, 2005, Little Rock, Arkansas. McCabe-Sellers, B.J. 2005. The contributions of USDA to public health nutrition. College of Public Health Seminar, May 31, 2005. McCabe-Sellers. B.J. 2005. Capacity building of communities and academia in the research process in the Lower Mississippi Delta Nutrition Intervention Research Initiative (NIRI). Fourth Annual Conference of the International Society of Behavioral Nutrition and Physical Activity (ISBNPA), June 16-18, 2005, Amsterdam, The Netherlands. McCabe-Sellers, B.J. 2005. Lower Mississippi Delta Nutrition Intervention Research Initiative Response to ARS Obesity Prevention Survey. June 28, 2005, Beltsville, Maryland. McCabe-Sellers, B.J. 2005. Summing for bone health. Society for Nutrition Education Annual Meeting, July 24, 2005, Orlando, Florida. Review Publications Black, M.M., Cutts, D.B., Frank, D.A., Geppert, J., Skalicky, A., Levenson, S., Casey, P.H., Berkowitz, C., Zaldivar, N., Cook, J.T., Meyers, A.F., Herren, T., C-SNAP Study Group. 2004. Special supplemental nutrition program for women, infants, and children participation and infants' growth and health: A multisite surveillance study. Pediatrics. 114:169-176. Weber, J.L., Going, S.B., Simpson, P.M., Lohman, T.G., Flick, E., Eklund, J., Gladstone, J. 2004. BMI underestimates obesity and related disease risk in 8-13 year old American Indian children [abstract]. Pediatric Research. 55(4):592A. Casey, P.H., Black, M., Cook, J., Goolsby, S., Frank, D., Berkowitz, C., Cutts, D., Meyers, A., Zaldivar, N., Heeren, T., Levenson, S., C-SNAP Study Group. 2004. Food insecurity is not associated with overweight status in 2 year old children [abstract]. Pediatric Research. 55(4):221A. Neault, N., Frank, D., Philipp, B., Merewood, A., Levenson, S., Heeren, T., Cook, J., Meyers, A., Casey, P., Cutts, D., Black, M., Zaldivar, N., Berkowitz, C. 2004. Impact of breastfeeding on child food security and health outcomes among an immigrant population [abstract]. Pediatric Research. 55(4):216A. Meyers, A., Cutts, D., Frank, D.A., Levenson, S., Skalicky, A., Cook, J., Berkowitz, C., Black, M., Casey, P., Zaldivar, N., Heeren, T. 2004. Subsidized housing and child nutritional status: Data from a multisite surveillance study [abstract]. Pediatric Research. 55(4):606A. Cook, J.T., Frank, D.A., Berkowitz, C., Black, M.M., Casey, P.H., Cutts, D.B., Meyers, A.F., Zaldivar, N., Skalicky, A., Levenson, S., Heeren, T., Nord, M. 2004. Food insecurity is associated with adverse health outcomes among human infants and toddlers. Journal of Nutrition. 134(6):1432-1438. Stuff, J.E., Casey, P.H., Szeto, K., Gossett, J., Weber, J., Simpson, P., Champagne, C., Connell, C., Harsha, D., Robbins, J., McCabe Sellers, B.J., Bogle, M.L. 2005. Household food insecurity and adult chronic disease in the Lower Mississippi Delta [abstract]. Journal of Federation of American Societies for Experimental Biology. 19(5):A986. McCabe Sellers, B.J., Champagne, C.M., Staggs, C.G., Allen, R., Bogle, M.L. 2005. Food choices and nutrient densities: What are the realities of food types [abstract]? Journal of Federation of American Societies for Experimental Biology. 19(4):A88. Hyman, E.N., McCabe Sellers, B.J., Strickland, E., Staggs, C.G., Bogle, M.L. 2005. A qualitative tool for assessing community readiness for nutrition and physical activity interventions: A component of community-based participatory research [abstract]. Journal of Federation of American Societies for Experimental Biology. 19(5):A1456. McCabe-Sellers, B.J., Staggs, C.G., Crawford, T., Wallace, R.L., Talbot, J.C., Bogle, M.L. 2005. "'Got Milk?' We Do!" The changing face of where rural America shops for food [abstract]. Journal of Federation of American Societies for Experimental Biology. 19(5):A1697. Johnson, G.S., Mcgee, B., Gossett, J., McCabe Sellers, B.J., Simpson, P., Bogle, M.L. 2005. Attitudes toward diet of older adults in the Lower Mississippi Delta (LMD) are not always consistent with dietary intake [abstract]. Journal of Federation of American Societies for Experimental Biology. 19(5):A1700. Kennedy, B.M., Paeratakul, S., Champagne, C., Ryan, D.H., Harsha, D.W., McGee, B., Johnson, G., Deyhim, F., Forsythe, W., Bogle, M.L. 2005. A pilot church-based weight loss program for African American adults utilizing church members as health educators: A comparison of individual and group intervention. Ethnicity and Disease. 15(3):373-378. Casey, P.H., Szeto, K.L., Robbins, J.M., Stuff, J.E., Connell, C., Gossett, J.M., Simpson, P.M. 2005. Child health related quality of life and household food security. Archives of Pediatrics and Adolescent Medicine. 159:51-56. Staggs, C.G., Sealey, W.M., McCabe, B.J., Mock, D.M. 2004. Determination of the biotin content of select foods using accurate and sensitive HPLC/avidin binding. Journal of Food Composition and Analysis. 17(2004):767-776. McGee, B.B., Gossett, J.M., Simpson, P.M., Johnson, G.S., Bogle, M.L. 2005. Diet quality, opionions and practices of adults in the Lower Mississippi Delta [abstract]. Journal of Federation of American Societies for Experimental Biology. 19(5):A1019. Harsha, D., Connell, C., Champagne, C., Casey, P., Robbins, J., Simpson, P., Stuff, J., Weber, J., McCabe-Sellers, B.J., Szeto, K., Gossett, J., Bogle, M.L. 2005. Food security and weight status in Lower Mississippi River Delta children [abstract]. Journal of Federation of American Societies for Experimental Biology. 19(5):A1023. McCabe Sellers, B.J., Staggs, C.G., Bogle, M.L. 2005. Assessment of histamine content in foods [abstract]. Proceedings of 29th National Nutrient Databank Conference. Abstract No. 4, p. 2. Tucker, K.L., Maras, J., Champagne, C., Connell, C., Goolsby, S., Weber, J., Zaghloul, S., Carithers, T., Bogle, M.L. 2005. A regional food-frequency questionnaire for the U.S. Mississippi Delta. Public Health Nutrition. 8(1):87-96. Molaison, E.F., Connell, C.L., Stuff, J.E., Yadrick, M.K., Bogle, M.L. 2005. Influences on fruit and vegetable consumption in low-income black american adolescents. Journal of Nutrition Education and Behavior. 37(5):246-251. Connell, C. L., Lofton, K. L., Yadrick, K., Rehner, T.A. 2005. Children's experiences of food insecurity can assist in understanding its effect on their well-being. Journal of Nutrition. 135:1683-1690. Casey, P., Horton, J., Bogle, M.L., Fomby, B., Forsythe, W., Goolsby, S., Gossett, J., Hyman, E., Kramer, T.R., Lovejoy, J., Rasco, M., Robbins, J., Simon, W., Simpson, P. 2004. Self reported health of residents of the Lower Mississippi Delta. Journal of Health Care for the Poor and Underserved. 15(4):645-662. Connell, C.L., Nord, M., Lofton, K.L., Yadrick, K. 2004. Food security of older children can be assessed using a standardized survey instrument. Journal of Nutrition. 134(10):2566-2572. McCabe Sellers, B.J., Bogle, M.L., Russell, L., Murphy, E., Howell, B., Prewitt, T. 2004. Expanding and enhancing partnerships between research and service. Proceedings of Overcoming Health Disparities: Global Experiences from Partnerships between Health Services and Health Professional Schools. 165. Connell, C., Lofton, K., Yadrick, K., Rehner, T. 2005. Through the eyes of a child: children's conceptualizations of food insecurity and hunger [abstract]. The Federation of American Societies for Experimental Biology. 19(5):A774. Abstract No. 449.8 Yadrick, K., Connell, C., Simpson, P., Goel, R., Gossett, J., Goolsby, S., Kramer, T.R., Bogle, M.L., McGee, B. 2005. Fats and sweets more available than fruits and vegetables in the rural Mississippi Delta [abstract]. The Federation of American Society for Experimental Biology. 19(5):A978. Abstract No. 574.6. Casey, P., Goolsby, S., Berkowitz, C., Frank, D., Cook, J., Cutts, D., Black, M.M., Zaldivar, N., Levenson, S., Heeren, T., Meyers, A., C-SNAP Study Group. 2004. Maternal depression, changing public assistance, food security, and child health status. Pediatrics. 113(2):298-304. McCabe-Sellers, B.J., Beattie, S.E. 2004. Food safety: Emerging trends in foodborne illness surveillance and prevention. Journal of The American Dietetic Association. 104:1708-1717. Davis, K.A., Azria-Evans, M., Brown, D.M., Lofton, K.L. 2004. Development of an instrument to measure diabetes self-efficacy in children [abstract]. Journal of The American Dietetic Association. 104(8):A-63 Lofton, K., Davis, K., Connell, C.L., Yadrick, M.K., Forsythe, W.A., Champagne, C.M., Stuff, J., Bogle, M.L. 2004. Food and nutrient intakes of southern african-american children participating in a summer sports and food assistance program [abstract]. Journal of The American Dietetic Association.104(8):A-18. Avis, A., Lofton, K., Lucas, G., Vassel, K., Strickland, E., Perkins, H. 2004. Using service learning to encourage nutrition and physical activity among high school students participating in a summer work program. In: 2004 Annual Community-Campus Partnership for Health Proceedings. p. 118. Ndirangu, M., Yadrick, M.K., Strickland, E., Santell, R., Perkins, H., Lucas, G., Bogle, M.L. 2004. Development of an evaluation framework for a community-academia partnership interveniton to encourage physical activity in a rural community in the Mississippi Delta community [abstract]. Proceedings of Annual Community-Campus Partnership for Health. p. 176. McCabe Sellers, B.J., Sharkey, J.R. 2004. Do older adults need closer monitoring of dietary b vitamins intake? Journal of The American Dietetic Association. 104(8) suppl 2:A-11. Staggs, C.G., McCabe Sellers, B.J., Yadrick, K., Bogle, M.L. 2005. Milk availability in the lower Mississippi Delta. Journal of Federation of American Societies for Experimental Biology. 19(5):A-1020. Abstract 594-4. McCabe Sellers, B.J., Sharkey, J.R., Champagne, C.M., Staggs, C.G., Bogle, M.L. 2005. Summing nutrients for bone health [abstract]. Proceedings of Society for Nutrition Education. 37:S29. Zoellner, J., Anderson, J., Gould, S.M. 2005. Comparative validation of a bilingual interactive multimedia dietary assessment tool. 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