Jennifer McCaffrey

Plain water consumption in relation to energy intake and diet quality among US adults, 2005–2012

OBJECTIVE The present study examined plain water consumption in relation to energy intake and diet quality among US adults. METHODS A nationally representative sample of 18 311 adults aged ≥18 years, from the National Health and Nutrition Examination Survey 2005-2012, was analysed. The first-difference estimator approach addressed confounding bias from time-invariant unobservables (e.g. eating habits, taste preferences) by using within-individual variations in diet and plain water consumption between two nonconsecutive 24-h dietary recalls. RESULTS One percentage point increase in the proportion of daily plain water in total dietary water consumption was associated with a reduction in mean (95% confidence interval) daily total energy intake of 8.58 (7.87-9.29) kcal, energy intake from sugar-sweetened beverages of 1.43 (1.27-1.59) kcal, energy intake from discretionary foods of 0.88 (0.44-1.32) kcal, total fat intake of 0.21 (0.17-0.25) g, saturated fat intake of 0.07 (0.06-0.09) g, sugar intake of 0.74 (0.67-0.82) g, sodium intake of 9.80 (8.20-11.39) mg and cholesterol intake of 0.88 (0.64-1.13) g. The effects of plain water intake on diet were similar across race/ethnicity, education attainment, income level and body weight status, whereas they were larger among males and young/middle-aged adults than among females and older adults, respectively. Daily overall diet quality measured by the Healthy Eating Index-2010 was not found to be associated with the proportion of daily plain water in total dietary water consumption. CONCLUSIONS Promoting plain water intake could be a useful public health strategy for reducing energy and targeted nutrient consumption in US adults, which warrants confirmation in future controlled interventions.

Adaptation and dissemination of an evidence-based obesity prevention intervention: Design of a comparative effectiveness trial

Low-income youth are at increased risk for excess weight gain. Although evidence-based prevention programs exist, successful adaptation to provide wide dissemination presents a challenge. Hip-Hop to Health (HH) is a school-based obesity prevention intervention that targets primarily preschool children of low-income families. In a large randomized controlled trial, HH was found to be efficacious for prevention of excessive weight gain. The Expanded Food and Nutrition Education Program (EFNEP) and the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) are USDA-funded nutrition education programs offered to low-income families, and may provide an ideal platform for the wide dissemination of evidence-based obesity prevention programs. A research-practice partnership was established in order to conduct formative research to guide the adaptation and implementation of HH through EFNEP and SNAP-Ed. We present the design and method of a comparative effectiveness trial that will determine the efficacy of HH when delivered by peer educators through these programs compared to the standard EFNEP and SNAP-Ed nutrition education (NE) curriculum. Results from this trial will inform larger scale dissemination. The dissemination of HH through government programs has the potential to increase the reach of efficacious obesity prevention programs that target low-income children and families.

Design and Evaluation of a Training Protocol for a Photographic Method of Visual Estimation of Fruit and Vegetable Intake among Kindergarten Through Second-Grade Students

Objective: To design a replicable training protocol for visual estimation of fruit and vegetable (FV) intake of kindergarten through second‐grade students through digital photography of lunch trays that results in reliable data for FV served and consumed. Methods: Protocol development through literature and researcher input was followed by 3 laboratory‐based trainings of 3 trainees. Lunchroom data collection sessions were done at 2 elementary schools for kindergarten through second‐graders. Intraclass correlation coefficients (ICCs) were used. Results: By training 3, ICC was substantial for amount of FV served and consumed (0.86 and 0.95, respectively; P < .05). The ICC was moderate for percentage of fruits consumed (0.67; P = .06). In‐school estimates for ICCs were all significant for amounts served at school 1 and percentage of FV consumed at both schools. Conclusions and Implications: The protocol resulted in reliable estimation of combined FV served and consumed using digital photography. The ability to estimate FV intake accurately will benefit intervention development and evaluation.

Promotoras and the Semantic Gap Between Latino Community Health Researchers and Latino Communities

Promotoras are identified as a unique group of community health workers adept at reducing health disparities. This qualitative study was conducted to better understand perceptions of the term promotora, broadly used in research but not well documented in everyday Latina vocabulary. Six focus groups to better understand perceptions of the term promotora were conducted with 36 Latina women living in three nonmetropolitan areas in Illinois. Results suggest that Latina participants in the study do not understand the meaning of “promotora” in the same way as it is used in the literature. Latina participants understood “promotoras” as referring to people who sell or deliver information, or organize events in the community that are not necessarily related to health events or community health work. Furthermore, they usually understood the term to refer to paid work rather than volunteering. Results underscore the importance of being sensitive to Latinas’ perceptions of community health terminology by assessing their context, needs, and expectations. These findings call researchers’ attention to the need to educate certain Latino communities about the concept of promotoras, with implications for the implementation and dissemination of promotora-led community health programs, as the semantic discrepancy could affect the recruitment of promotoras as well as community participation in the programs they deliver.

Assessing the Network of Agencies in Local Communities that Promote Healthy Eating and Lifestyles among Populations with Limited Resources

OBJECTIVES We assessed the network of agencies in local communities that promote healthy eating and lifestyles among populations with limited resources. METHODS Network surveys were administered among 159 Illinois agencies identified as serving limited-resource audiences categorized into 8 types: K-12 schools, early childhood centers, emergency food providers, health-related agencies, social resource centers, low-income/subsidized housing complexes, continuing education organizations, and others. Network analysis was conducted to examine 4 network structures - communications, funding, cooperation, and collaboration networks between agencies within each county/county cluster. RESULTS Agencies in a network were found to be loosely connected, indicated by low network density. Reporting accuracy might be of concern, indicated by low reciprocity. Agencies in a network are decentralized rather than centralized around a few influential agencies, indicated by low betweenness centrality. There is suggestive evidence regarding homophily in a network, indicated by some significant correlations within agencies of the same type. Agencies connected in one network are significantly more likely to be connected in all the other networks as well. CONCLUSIONS Promoting healthy eating and lifestyles among populations with limited resources warrants strong partnership across agencies in communities. Network analysis serves as a useful tool to evaluate community partnerships and facilitate coalition building..

Examining Internet Access and Social Media Application Use for Online Nutrition Education in SNAP-Ed Participants in Rural Illinois

Objective: To examine Internet access and interest in receiving nutrition education via social media applications among low‐income adults participating in the Supplemental Nutrition Assistance Program Education (SNAP‐Ed). Methods: A cross‐sectional survey was distributed during 25 SNAP‐Ed classes throughout the 16 southernmost counties of Illinois. Results: From 188 responses, the majority of participants had Internet access (76%). Among participants aged 18–32 years (n = 51), 92% owned a smartphone with Internet access and 57% indicated that they would use online nutrition education, with most interest in e‐mail (41%), Facebook (40%), and text messaging (35%). There was little interest in using blogs, Vine, Twitter, Tumblr, and Pinterest. Overall, 49% of middle‐aged adults aged 33–64 years and 87% of seniors aged ≥65 years reported they would not use online nutrition education. Conclusions and Implications: Results indicated similar Internet accessibility in southern Illinois among low‐income populations compared with national rural rates. Interest in using online nutrition education varied among SNAP‐Ed participants according to age. Young adults appeared to be the most captive audience regarding online nutrition education. Results may be useful to agencies implementing SNAP‐Ed to supplement current curriculum with online nutrition education for audiences aged ≤32 years.

Community partnerships in healthy eating and lifestyle promotion: A network analysis

Promoting healthy eating and lifestyles among populations with limited resources is a complex undertaking that often requires strong partnerships between various agencies. In local communities, these agencies are typically located in different areas, serve diverse subgroups, and operate distinct programs, limiting their communication and interactions with each other. This study assessed the network of agencies in local communities that promote healthy eating and lifestyles among populations with limited resources. Network surveys were administered in 2016 among 89 agencies located in 4 rural counties in Michigan that served limited-resource audiences. The agencies were categorized into 8 types: K-12 schools, early childhood centers, emergency food providers, health-related agencies, social resource centers, low-income/subsidized housing complexes, continuing education organizations, and others. Network analysis was conducted to examine 4 network structures—communication, funding, cooperation, and collaboration networks between agencies within each county. Agencies had a moderate level of cooperation, but were only loosely connected in the other 3 networks, indicated by low network density. Agencies in a network were decentralized rather than centralized around a few influential agencies, indicated by low centralization. There was evidence regarding homophily in a network, indicated by some significant correlations within agencies of the same type. Agencies connected in any one network were considerably more likely to be connected in all the other networks as well. In conclusion, promoting healthy eating and lifestyles among populations with limited resources warrants strong partnership between agencies in communities. Network analysis serves as a useful tool to evaluate community partnerships and facilitate coalition building.

Nutrition Environment Food Pantry Assessment Tool (NEFPAT): Development and Evaluation

Objective To develop and evaluate a nutrition environment assessment tool to assess the consumer nutrition environment and use of recommended practices in food pantries. Methods The Nutrition Environment Food Pantry Assessment Tool (NEFPAT) was developed based on a literature review and guidance from professionals working with food pantries. The tool was pilot‐tested at 9 food pantries, an expert panel assessed content validity, and interrater reliability was evaluated by pairs in 3 pantries. After revisions, the NEFPAT was used in 27 pantries. Results Pilot tests indicated positive appraisal for the NEFPAT and recommendations were addressed. The NEFPATs 6 objectives and the overall tool were rated as content valid by experts, with an average section rating of 3.85 ± 0.10. Intraclass correlation coefficients for interrater reliability were >0.90. Conclusions and Implications The NEFPAT is content valid with high interrater reliability. It provides baseline data that could be valuable for interventions within the nutrition environment of food pantries.