- Email: [email protected]
NP21 Advancing and Expanding HomeStyles: Shaping HOME Environments and LifeSTYLES to Prevent Childhood Obesity
Journal of Nutrition Education and Behavior Volume 51, Number 7S, 2019 NP19 (continued) discount on groceries and tracked purchases during the three-month baseline and six-month intervention periods. The primary outcome was change in weekly spending on FV from baseline to follow-up in intervention and control groups. We also compared changes from baseline to follow-up in daily servings of FV among parents and children using a 135-item food frequency questionnaire. A baseline survey asked about the household’s participation in the Supplemental Nutrition Assistance Program (SNAP), income, and food insecurity. Subgroup analyses compared intervention effects by SNAP participation. Evaluation: At baseline, half of participants reported food insecurity. Overall, 52% were income-eligible for SNAP, and 32% participated in SNAP. Cooking Matters participation was low (11%). Compared to control, the intervention group increased weekly spending on FV by 23% ($2.23, 95% CI = $1.00, $3.46); among SNAP participants, the intervention group increased weekly spending by 43% ($2.17, 95% CI = $0.84, $3.50). Preliminary analyses revealed no overall change in FV consumption among parents or children. Conclusions and Implications: Supermarket financial incentives increase household purchases of FV among SNAP and non-SNAP participants, with no evidence of increased spending on other, unhealthful foods and beverages. Funding: 2016-68001-24961.
NP20 Starting Early: Expansion of a Primary Care-Based Early Child Obesity Prevention Program Mary Jo Messito, MD, [email protected], NYU School of Medicine, 462 First Ave, New York, NY 10016; Michelle Katzow, MS, MD, NYU School of Medicine; Alan Mendelsohn, MD, NYU School of Medicine; Rachel Gross, MS, MD, NYU School of Medicine Objective: Determine “Starting Early Program” (StEP) impacts on infant feeding practices and weight and develop expanded prenatal and pre-school StEP interventions. Description: We conducted a randomized controlled trial testing the efficacy of StEP, a comprehensive early child obesity prevention program using prenatal and pediatric primary care to target low-income, Hispanic families. English/Spanish speaking pregnant Hispanic women were enrolled in the third trimester to standard primary care control group vs. StEP intervention group (prenatal/postpartum nutrition counseling, and nutrition and parenting support groups coordinated with well-child visits until child age three years). Expanded prenatal and preschool StEP curricula for women beginning in the first trimester and children aged 3-5 years were developed. Evaluation: Intervention outcomes assessed at child age 3, 10, 19 months and 2, 3, 4 and 5 years. Maternal infant feeding and activity practices assessed using 24-hour diet recalls and validated surveys. Measured child weight for
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age z-scores (WFAz) determined from CDC growth charts. Intent to treat analyses and within group analyses for intervention dose impacts were conducted. We randomized 533 low-income women into the original trial. 88%, 78%, 74%, 76% and 75% of mother-infant pairs completed assessments at 3, 10, and 19 months, and 2 and 3 years. Intervention pairs had healthier feeding and activity practices (more exclusive breastfeeding, tummy time; less cereal in the bottle, excess milk intake and non-responsive feeding styles). By age two, intervention group infants had lower WFAz than controls (0.62(1.11) vs. 0.85(1.17); P = .046). Median number of sessions attended was 7.0(SD3.5)/12. High attendance reduced the odds of being overweight (AOR 0.42, P = .02). To date, a new expanded prenatal cohort is being enrolled in the 1st trimester (goal n = 200); 309 pairs from the original cohort enrolled for continuation, 4- and 5-year assessments on-going. Conclusion and Implications: StEP intervention infants had healthier feeding practices and lower weight at two years, with dose dependent reduction in overweight. Findings demonstrate a scalable system to potentially augment obesity prevention in primary care for atrisk families. Funding: 2017-68001-26350.
NP21 Advancing and Expanding HomeStyles: Shaping HOME Environments and LifeSTYLES to Prevent Childhood Obesity Carol Byrd-Bredbenner, PhD, RD, FAND, bredbenner@sebs. rutgers.edu, Rutgers University, 26 Nichol Ave, New Brunswick, NJ 08901; Karla Shelnutt, PhD, RDN, University of Florida; Melissa D. Olfert, DPH, RDN, West Virginia University Objective: This multi-disciplinary, multi-institutional, multi-state, integrated research, education, and extension project will advance and expand the progress of HomeStyles toward reducing risk of childhood overweight and obesity. Description: HomeStyles, an in-home family intervention, enables and motivates parents to shape home environments and weight-related lifestyle practices to prevent childhood obesity. Segment one of HomeStyles focused families with preschoolers (ages 2-5). A dissemination feasibility study was launched to determine how to effectively diffuse the innovations of the evidence-based HomeStyles-Segment one intervention to parents of children in preschools/daycares. The creation of a novel, culturally-competent HomeStyles-Segment two responsive to the developmentally unique needs of middle childhood (6-11 years) is in development for delivery online and in face-to-face SNAP-Ed sessions. Further, this project continues to build the expertise of the next generation of nutrition and health education professionals in creating effective childhood obesity prevention programs through formal coursework and hands-on practicums. Evaluation: The dissemination feasibility study for Segment one includes pre/post surveys completed by a key Continued on page S20
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Journal of Nutrition Education and Behavior Volume 51, Number 7S, 2019
NP21 (continued) informant at each participating preschool/daycare and brief parent surveys. The new, second segment of HomeStyles tailored to families with children 6 to 11 years will be evaluated via a randomized controlled trial designed to determine whether this novel, age-appropriate, family intervention enables and motivates English- and Spanishspeaking parents to shape their home environments and weight-related lifestyle practices (diet, exercise, sleep) to reduce risk of obesity during middle childhood more than those in the control condition. Students enrolled in coursework and practicums will continue to be evaluated using rubrics and satisfaction surveys. Conclusions and Implications: This intervention will apply community-based participatory research principles and be aligned with current obesity prevention recommendations and behavior change theories. This project will provide a sustainable model for confronting and combating obesity and safeguarding health that can be brought to scale nationwide. Funding: 2017-68001-26351.
NP22 Development of the Children Eating Well (CHEW) Mobile Application for WIC Families in Tennessee Pamela Hull, PhD, [email protected], Vanderbilt University Medical Center, 2525 West End, Ste 800, Nashville, TN 37203; Elyse Shearer, PhD, Tennessee State University; Summer Weber, PhD, Vanderbilt University Medical Center; Douglas Schmidt, PhD, Vanderbilt University; Jessica Jones, MA, Vanderbilt University Medical Center; Calvin Harris, BS, Tennessee State University; Shelagh Mulvaney, PhD, Vanderbilt University Objective: Mobile applications (‘apps’) for WIC families are becoming increasingly prevalent, especially in states that have transitioned from paper vouchers to electronic benefits transfer (EBT) for WIC. Apps and other digital technologies can improve the WIC experience by helping participants check their benefit balance, scan food items to determine WIC eligibility, streamline service delivery, and provide additional nutrition education. The Children Eating Well (CHEW) app aims to maximize redemption of WIC foods and improve overall diet quality of preschoolaged participants by facilitating benefit redemption at the store and providing easy, practical ways for parents to increase consumption of healthy foods through healthy recipes, quizzes, and goal setting features. The objective is to report on the findings of user testing and development during the preparation of version 2.0 of the CHEW app. Description: Our team conducted qualitative interviews families of WIC children aged 2-4 years in an iterative process to inform user-centered development of version 2.0 and to maximize usability of the app. Evaluation: Using a sorting activity, participants were asked to rank potential in-app features by importance then place the cards into natural groupings of similar features. Participants were also asked to form mental models about using recipes, shopping lists, using WIC benefits,
and checking their WIC balance. We will report on qualitative findings that informed the user interface, improvement of shopping tools, and format of nutrition education features. We will also describe how we are collaborating with partners and outline ways that potential partners can collaborate with the CHEW team to disseminate existing nutrition education content to WIC participants through the CHEW app in the future. Conclusion and Implications: The CHEW 2.0 app will be implemented in WIC clinics across the state of Tennessee as a supplemental education tool for families to use at home, with plans for future dissemination to other states. These formative findings can also inform the development of other technology applications for the WIC program. Funding: 2017-68001-26352.
NP23 Garden-Based Intervention for Youth Improves Dietary and Physical Activity Patterns, Quality of Life, Family Relationships, and Indices of Health Ingrid Adams, PhD, LD, RDN, The Ohio State University; Ashlea Braun, MS, LD, RDN, The Ohio State University; Emily Hill, MS, LD, RDN, The Ohio State University; Khawlah Al-Muhanna, MS, LD, RDN, The Ohio State University; Nicole Stigall, MS, RDMS, RVT, The Ohio State University; Jenny Lobb, MS, LD, RDN, The Ohio State University; Joseph Rausch, PhD, Nationwide Children’s Hospital; James Portner, MSW, The Ohio State University; Kevin Evans, PhD, RT(R) (M) (BD), RDMS, RVS, FSDMS, FAIUM, The Ohio State University; Colleen Spees, PhD, LD, RDN, FAND, [email protected], The Ohio State University, 453 W 10th Ave, 170 Atwell Hall, Columbus, OH 43210 Objective: Childhood obesity remains a significant health issue, especially in disparate populations and during the summer months, when millions of children lose access to school-based feeding programs and suffer gaps in meals. The objective of this study was to measure the efficacy of a three-month garden-based summer intervention targeting low-resource youth. Description: Summer Harvest Adventure (SHA) is a fiveyear randomized controlled trial targeting children and parent/adult caregivers (PAC). In year one (of three), a total of 72 children (ages 8-11 years) were randomized to a garden-based intervention or enhanced control group. The intervention consisted of theoretical-driven and evidence-based group education, produce (fruits, vegetables, and herbs) harvesting, cooking demonstrations, remote motivational interviewing, and e-technologies. Data collected at baseline (month zero) and post-intervention (month three) included sociodemographics, quality of life, dietary patterns, family dynamics, program satisfaction; anthropometrics, body composition, physical activity, cardiovascular risk, and skin carotenoids were measured objectively. Evaluation: Sixty-four percent of SHA participants met study adherence criteria (> 75% attendance). The mean age of enrolled was 8.7 (+/- 0.47) years with 50% male and Continued on page S21
NP20 Starting Early: Expansion of a Primary Care-Based Early Child Obesity Prevention Program Mary Jo Messito, MD, [email protected], NYU School of Medicine, 462 First Ave, New York, NY 10016; Michelle Katzow, MS, MD, NYU School of Medicine; Alan Mendelsohn, MD, NYU School of Medicine; Rachel Gross, MS, MD, NYU School of Medicine Objective: Determine “Starting Early Program” (StEP) impacts on infant feeding practices and weight and develop expanded prenatal and pre-school StEP interventions. Description: We conducted a randomized controlled trial testing the efficacy of StEP, a comprehensive early child obesity prevention program using prenatal and pediatric primary care to target low-income, Hispanic families. English/Spanish speaking pregnant Hispanic women were enrolled in the third trimester to standard primary care control group vs. StEP intervention group (prenatal/postpartum nutrition counseling, and nutrition and parenting support groups coordinated with well-child visits until child age three years). Expanded prenatal and preschool StEP curricula for women beginning in the first trimester and children aged 3-5 years were developed. Evaluation: Intervention outcomes assessed at child age 3, 10, 19 months and 2, 3, 4 and 5 years. Maternal infant feeding and activity practices assessed using 24-hour diet recalls and validated surveys. Measured child weight for
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age z-scores (WFAz) determined from CDC growth charts. Intent to treat analyses and within group analyses for intervention dose impacts were conducted. We randomized 533 low-income women into the original trial. 88%, 78%, 74%, 76% and 75% of mother-infant pairs completed assessments at 3, 10, and 19 months, and 2 and 3 years. Intervention pairs had healthier feeding and activity practices (more exclusive breastfeeding, tummy time; less cereal in the bottle, excess milk intake and non-responsive feeding styles). By age two, intervention group infants had lower WFAz than controls (0.62(1.11) vs. 0.85(1.17); P = .046). Median number of sessions attended was 7.0(SD3.5)/12. High attendance reduced the odds of being overweight (AOR 0.42, P = .02). To date, a new expanded prenatal cohort is being enrolled in the 1st trimester (goal n = 200); 309 pairs from the original cohort enrolled for continuation, 4- and 5-year assessments on-going. Conclusion and Implications: StEP intervention infants had healthier feeding practices and lower weight at two years, with dose dependent reduction in overweight. Findings demonstrate a scalable system to potentially augment obesity prevention in primary care for atrisk families. Funding: 2017-68001-26350.
NP21 Advancing and Expanding HomeStyles: Shaping HOME Environments and LifeSTYLES to Prevent Childhood Obesity Carol Byrd-Bredbenner, PhD, RD, FAND, bredbenner@sebs. rutgers.edu, Rutgers University, 26 Nichol Ave, New Brunswick, NJ 08901; Karla Shelnutt, PhD, RDN, University of Florida; Melissa D. Olfert, DPH, RDN, West Virginia University Objective: This multi-disciplinary, multi-institutional, multi-state, integrated research, education, and extension project will advance and expand the progress of HomeStyles toward reducing risk of childhood overweight and obesity. Description: HomeStyles, an in-home family intervention, enables and motivates parents to shape home environments and weight-related lifestyle practices to prevent childhood obesity. Segment one of HomeStyles focused families with preschoolers (ages 2-5). A dissemination feasibility study was launched to determine how to effectively diffuse the innovations of the evidence-based HomeStyles-Segment one intervention to parents of children in preschools/daycares. The creation of a novel, culturally-competent HomeStyles-Segment two responsive to the developmentally unique needs of middle childhood (6-11 years) is in development for delivery online and in face-to-face SNAP-Ed sessions. Further, this project continues to build the expertise of the next generation of nutrition and health education professionals in creating effective childhood obesity prevention programs through formal coursework and hands-on practicums. Evaluation: The dissemination feasibility study for Segment one includes pre/post surveys completed by a key Continued on page S20
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Poster Abstracts
Journal of Nutrition Education and Behavior Volume 51, Number 7S, 2019
NP21 (continued) informant at each participating preschool/daycare and brief parent surveys. The new, second segment of HomeStyles tailored to families with children 6 to 11 years will be evaluated via a randomized controlled trial designed to determine whether this novel, age-appropriate, family intervention enables and motivates English- and Spanishspeaking parents to shape their home environments and weight-related lifestyle practices (diet, exercise, sleep) to reduce risk of obesity during middle childhood more than those in the control condition. Students enrolled in coursework and practicums will continue to be evaluated using rubrics and satisfaction surveys. Conclusions and Implications: This intervention will apply community-based participatory research principles and be aligned with current obesity prevention recommendations and behavior change theories. This project will provide a sustainable model for confronting and combating obesity and safeguarding health that can be brought to scale nationwide. Funding: 2017-68001-26351.
NP22 Development of the Children Eating Well (CHEW) Mobile Application for WIC Families in Tennessee Pamela Hull, PhD, [email protected], Vanderbilt University Medical Center, 2525 West End, Ste 800, Nashville, TN 37203; Elyse Shearer, PhD, Tennessee State University; Summer Weber, PhD, Vanderbilt University Medical Center; Douglas Schmidt, PhD, Vanderbilt University; Jessica Jones, MA, Vanderbilt University Medical Center; Calvin Harris, BS, Tennessee State University; Shelagh Mulvaney, PhD, Vanderbilt University Objective: Mobile applications (‘apps’) for WIC families are becoming increasingly prevalent, especially in states that have transitioned from paper vouchers to electronic benefits transfer (EBT) for WIC. Apps and other digital technologies can improve the WIC experience by helping participants check their benefit balance, scan food items to determine WIC eligibility, streamline service delivery, and provide additional nutrition education. The Children Eating Well (CHEW) app aims to maximize redemption of WIC foods and improve overall diet quality of preschoolaged participants by facilitating benefit redemption at the store and providing easy, practical ways for parents to increase consumption of healthy foods through healthy recipes, quizzes, and goal setting features. The objective is to report on the findings of user testing and development during the preparation of version 2.0 of the CHEW app. Description: Our team conducted qualitative interviews families of WIC children aged 2-4 years in an iterative process to inform user-centered development of version 2.0 and to maximize usability of the app. Evaluation: Using a sorting activity, participants were asked to rank potential in-app features by importance then place the cards into natural groupings of similar features. Participants were also asked to form mental models about using recipes, shopping lists, using WIC benefits,
and checking their WIC balance. We will report on qualitative findings that informed the user interface, improvement of shopping tools, and format of nutrition education features. We will also describe how we are collaborating with partners and outline ways that potential partners can collaborate with the CHEW team to disseminate existing nutrition education content to WIC participants through the CHEW app in the future. Conclusion and Implications: The CHEW 2.0 app will be implemented in WIC clinics across the state of Tennessee as a supplemental education tool for families to use at home, with plans for future dissemination to other states. These formative findings can also inform the development of other technology applications for the WIC program. Funding: 2017-68001-26352.
NP23 Garden-Based Intervention for Youth Improves Dietary and Physical Activity Patterns, Quality of Life, Family Relationships, and Indices of Health Ingrid Adams, PhD, LD, RDN, The Ohio State University; Ashlea Braun, MS, LD, RDN, The Ohio State University; Emily Hill, MS, LD, RDN, The Ohio State University; Khawlah Al-Muhanna, MS, LD, RDN, The Ohio State University; Nicole Stigall, MS, RDMS, RVT, The Ohio State University; Jenny Lobb, MS, LD, RDN, The Ohio State University; Joseph Rausch, PhD, Nationwide Children’s Hospital; James Portner, MSW, The Ohio State University; Kevin Evans, PhD, RT(R) (M) (BD), RDMS, RVS, FSDMS, FAIUM, The Ohio State University; Colleen Spees, PhD, LD, RDN, FAND, [email protected], The Ohio State University, 453 W 10th Ave, 170 Atwell Hall, Columbus, OH 43210 Objective: Childhood obesity remains a significant health issue, especially in disparate populations and during the summer months, when millions of children lose access to school-based feeding programs and suffer gaps in meals. The objective of this study was to measure the efficacy of a three-month garden-based summer intervention targeting low-resource youth. Description: Summer Harvest Adventure (SHA) is a fiveyear randomized controlled trial targeting children and parent/adult caregivers (PAC). In year one (of three), a total of 72 children (ages 8-11 years) were randomized to a garden-based intervention or enhanced control group. The intervention consisted of theoretical-driven and evidence-based group education, produce (fruits, vegetables, and herbs) harvesting, cooking demonstrations, remote motivational interviewing, and e-technologies. Data collected at baseline (month zero) and post-intervention (month three) included sociodemographics, quality of life, dietary patterns, family dynamics, program satisfaction; anthropometrics, body composition, physical activity, cardiovascular risk, and skin carotenoids were measured objectively. Evaluation: Sixty-four percent of SHA participants met study adherence criteria (> 75% attendance). The mean age of enrolled was 8.7 (+/- 0.47) years with 50% male and Continued on page S21