Jesse Stabile Morrell

Metabolic Syndrome, Obesity, and Related Risk Factors Among College Men and Women

Abstract Objectives: The primary objective of this study was to characterize the prevalence of overweight/obesity, metabolic syndrome (MbS) and its criteria, and nutrient intakes of college-age men and women via a large-scale screening. Participants and Methods: From August 2005 to July 2008, 2,722 subjects were recruited for the ongoing, cross-sectional Young Adult Health Risk Screening Initiative project. Anthropometric, biochemical, clinical, and dietary data were collected. Results: Approximately one-half of men and more than one-quarter of women were overweight or obese. MbS was identified in 9.9% of men and 3.0% of women; 77% of men and 54% of women had at least 1 MbS criterion. Intakes of saturated fat, magnesium, and fiber, as well as body mass index and reported physical activity levels were related to MbS. Conclusions: Because of high rates of overweight/obesity and MbS, college-age adults are at risk for developing chronic diseases including diabetes mellitus and cardiovascular disease

The University of New Hampshire's Young Adult Health Risk Screening Initiative

Few comprehensive studies exist that evaluate the nutrient intake and health indicators of college-aged students. This article describes the University of New Hampshires Young Adult Health Risk Screening Initiative and examines results from participants evaluated from September 2005 through July 2007. This cross-sectional study included 1,701 students who enrolled in an introductory nutrition course, met age requirements (18 to 24 years), agreed to participate, and completed related assessments. All evaluation components were built into the semester-long course design, thus minimizing participant burden. Anthropometric measurements, blood lipids, blood glucose, and blood pressure were measured directly by research staff. Online dietary intake was self-reported and evaluated using a software program. Health risk data indicate high rates of overweight (33%), elevated low-density lipoprotein cholesterol (53%), and elevated systolic (47%) and diastolic blood pressures (39%). Less than 30 minutes of physical activity per day was reported by 28% of respondents. The majority of males (94%) and females (73%) exceeded sodium guidelines. Although females were less likely to be overweight than males, few met recommended intakes for vitamin D (26%), calcium (25%), potassium (35%), iron (31%), and folate (32%). Undergraduate and graduate dietetics students assisted with biological assessments, data entry, and record maintenance. Data inclusion rates ranged between 84% and 94% for various measurements. The methods employed in this study could be modified by institutions interested in profiling the health status of students. Results have led to an enhanced understanding of the nutrition practices and health status of this population and will serve to inform university programs and policies.

The Effects of Young Adults Eating and Active for Health (YEAH): A Theory-Based Web-Delivered Intervention

OBJECTIVE To assess the effectiveness of a tailored theory-based, Web-delivered intervention (Young Adults Eating and Active for Health) developed using community-based participatory research process. DESIGN A 15-month (10-week intensive intervention with a 12-month follow-up) randomized, controlled trial delivered via Internet and e-mail. SETTING Thirteen college campuses. PARTICIPANTS A total of 1,639 college students. INTERVENTION Twenty-one mini-educational lessons and e-mail messages (called nudges) developed with the non-diet approach and focusing on eating behavior, physical activity, stress management, and healthy weight management. Nudges were short, frequent, entertaining, and stage-tailored to each behavior, and reinforced lesson content. MAIN OUTCOME MEASURE All participants were assessed at baseline, postintervention (3 months from baseline), and follow-up (15 months from baseline) for primary outcomes of weight, body mass index (BMI), fruit and vegetable intake (FVI), physical activity (PA), and perceived stress; and secondary outcomes of waist circumference, percent dietary fat, energy from sugar-sweetened beverages, servings of whole grains, self-instruction and regulation for mealtime behavior, hours of sleep, and stage of readiness for change for consuming 5 cups of FVI, completing 150 minutes of PA/wk, and managing stress on most days of the week. Demographics were collected at baseline. ANALYSIS Chi-square analysis and mixed-models repeated measures analysis were performed to determine differences between experimental and control outcomes. RESULTS There were no differences between experimental and control participants in BMI, weight, and waist circumference. There were small improvements in FVI (P = .001), vigorous PA in females (P = .05), fat intake (P = .002), self-instruction (P = .001), and regulation (P = .004) for mealtime behavior, and hours of sleep (P = .05) at postintervention, but improvements were not maintained at follow-up. At postintervention, a greater proportion of experimental participants were in the action/maintenance stages for FVI (P = .019) and PA (P = .002) than control. CONCLUSIONS AND IMPLICATIONS Young Adults Eating and Active for Health is one of the first studies to use the community-based participatory research process of PRECEDE-PROCEED to develop a non-diet approach intervention. Although there were no differences between experimental and control participants in weight change or BMI, the intervention supported positive change in behaviors that may mediate excessive weight gain, such as increasing FVI and more healthful self-regulation mealtime behaviors immediately postintervention. Additional strategies to maintain the behavior changes need to be explored.

Development of Young Adults Eating and Active for Health (YEAH) Internet-Based Intervention via a Community-Based Participatory Research Model

OBJECTIVE To develop a tailored, theory-based, Web-delivered intervention to prevent excessive weight gain in young adults using a Community-Based Participatory Research model. DESIGN Investigators from 14 universities developed the intervention and supporting administrative portal using the 4 phases of the PRECEDE model. Steering committees were composed of the target audience (aged 19-24 years) and key health/wellness personnel were formed at each institution and provided information during each phase that was used to guide development of the intervention, Project YEAH (Young Adults Eating and Active for Health). Piloting results were used to refine the curriculum and identify and avoid barriers to delivery. RESULTS Qualitative and quantitative data collected at each phase informed Project YEAH development. In Phase 1, factors of highest priority to young adults were identified. In Phase 2, environmental supports for healthful lifestyles were elucidated. In Phase 3, behavior and environmental changes considered important and changeable were identified. In Phase 4, the 10-week, theory-based, stage-tailored, interactive-learning intervention with a 10-month reinforcement period was developed. CONCLUSIONS AND IMPLICATIONS Applying the PRECEDE model with fidelity during development of Project YEAH resulted in an intervention that pilot participants found relevant and useful, gained attention, instilled confidence in the ability to apply the information, and provided a sense of satisfaction.

Cardiovascular Fitness, Activity, and Metabolic Syndrome Among College Men and Women

BACKGROUND The purpose of this cross-sectional study was to examine the impact of below-average cardiovascular fitness and inactivity on the metabolic syndrome among an understudied population-undergraduate men and women, ages 18-24 years. METHODS Between January, 2010, and May, 2012, we assessed anthropometric, biochemical, and clinical measures in a convenience sample of students (n=1610) enrolled in an introductory nutrition course at a public university. We quantified the prevalence of metabolic syndrome criteria, estimated cardiovascular fitness via a 1-mile Rockport Walk Test, and evaluated daily activity via pedometer. Subjects were classified as below-average, average, and above-average fitness based upon the Rockport Walk Test; activity levels were classified as low active, somewhat active, active, or highly active according to average steps per day. RESULTS Those with below-average fitness (10%) were at increased risk for being overfat, having abdominal obesity, and having the metabolic syndrome as compared to those with average or above-average fitness (odds ratio: 12.4, 10.0, and 4.7, respectively; all P<0.01). Twenty percent of subjects were low active (<7500 steps/day) and had a greater number of metabolic syndrome criteria as compared to very active subjects (>12,500 steps/day) (0.94±0.05 vs. 0.73±0.05, P=0.01). CONCLUSIONS Young, college-age adults with below-average cardiovascular fitness and/or low activity levels are at increased risk for obesity and the metabolic syndrome. Future studies should examine how promoting lifestyle habits that increase physical activity and reduce sedentary behaviors during the young adult years can improve metabolic health.

Metabolic Syndrome: Comparison of Prevalence in Young Adults at 3 Land-Grant Universities.

Abstract Objective: The study examines metabolic syndrome (MetS) among college students at 3 geographically distinct US campuses. Participants: Undergraduates (N = 360; 68% women), 18 to 24 years of age, were recruited at each public university in January and February 2011. MetS prevalence was evaluated in 83% (n = 299) participants. Methods: Anthropometric, biochemical, and clinical measures were collected in the fasted state. Results: Twelve percent of college men and 6% of college women met the clinical definition of MetS. Males were more likely to have ≥2 individual MetS criteria than females (33% vs 16%; p < .05). Prevalence and individual criteria of MetS differed between the 3 regions. Obese and overweight students met significantly more MetS criteria and had higher C-reactive protein levels than normal-weight students (both p < .05). Conclusion: Findings suggest that MetS prevalence among college students differs by sex, weight status, and region. Further research is needed to identify effective, targeted interventions that are regionally appropriate for this population.

Recruitment lessons learned from a tailored web-based health intervention project Y.E.A.H. (young adults eating and Active for health)

Purpose – Recruiting college students for research studies can be challenging. The purpose of this paper is to describe the lessons learned in the various recruitment strategies used for enrolling college students in a theory-based, tailored, and web-delivered health intervention at 13 US universities. Design/methodology/approach – The community-based participatory research (CBPR) model was used to develop a staged-tailored, web-based, randomized control trial, focussing on eating behavior, physical activity, and stress management. Participant feedback during baseline assessments was used to evaluate recruitment strategies. Findings – Findings from this feedback suggest that traditional recruitment strategies, such as newspaper ads and flyers, may not be the best approach for recruiting college students; instead, web-based efforts proved to be a better recruitment strategy. Research limitations/implications – This project included results from 13 US universities and thus may not be generalizable: more res...

PACES: A Physical Activity Campus Environmental Supports Audit on University Campuses

Purpose. This study evaluated the policy and built and recreation environmental supports for physical activity on 13 university campuses. Design. Environmental audit survey. Setting. Thirteen U.S. universities, 2009. Subjects. University policies, recreation programs and facilities, and at least five additional buildings per campus. Measures. The Physical Activity Campus Environmental Supports Audit was developed for this study. Analysis. Analysis of variance with post hoc Tukeys B and χ2 assessed differences by institution and building type. Results. The mean obesogenic policy score was significantly lower than the desired score, ≥ 7 (p = .002), with only one campus scoring 10. The mean built environment audit score (5.4 ± 1.7) was low, with significant differences between institutions (p < .001) and only three campuses scoring above the desired score, ≥ 7. Although generally stairwells were clean and well lighted, there was a lack of signage to encourage stair use (p < .001). Overall, recreation programs (7.1 ± .7) and facilities (7.1 ± 1.2) scored well, but amenities scores were lower for satellite (2.8 ± 1.6) versus main (4.1 ± 1.8) recreation facilities (p = .04). Conclusion. On these 13 university campuses, recreation programs and facilities were supportive of healthful lifestyles for obesity prevention, but policies and the built environment were not. This physical activity environmental audit survey requires testing in a wider sample of postsecondary institutions to corroborate its utility and provide evidence to support initiatives to improve campus environments for physical activity.

Path Analysis of Campus Walkability/Bikeability and College Students’ Physical Activity Attitudes, Behaviors, and Body Mass Index:

Purpose: The purpose of this study was to assess the relationship between the walkability/bikeability of college campuses and students’ body mass index (BMI) with student physical activity (PA) attitudes and behaviors as potential mediators. Design: Cross-sectional. Setting: Thirteen university campuses. Participants: A total of 1384 student participants. Measures: Walkability/bikeability environmental score (ES): 12-item audit assessed an average of 44 path segments per campus. Students were measured for height and weight and completed online surveys. Physical activity stage of change/behavior intentions were assessed using the transtheoretical model. The Cognitive Behavioral Physical Activity Questionnaire assessed outcome expectations, self-regulation, and personal barriers. International Physical Activity Questionnaire assessed walking-, moderate-, and vigorous-intensity PA. Analysis: Descriptive statistics, zero-order correlations, and path analysis with maximum likelihood estimation. Results: The overall model fit was good with χ2 of 171.388 (df = 18), P < .001, comparative fit index value of .95, and a root mean square of approximation of .079. After controlling for gender, there was a direct negative association between walkability/bikeability ES and BMI (β = −.085) and positive association between personal barriers and BMI (β = .134). Walkability/bikeability ES was positively associated with walking-intensity PA (β = .010). Self-regulation was positively associated with moderate-intensity PA (β = .213), which, in turn, was negatively associated with BMI (β = −.057). Conclusions: The ease of walking and biking on a campus was related to college students’ walking behavior and their BMI. Students’ PA behavioral intentions were associated with moderate PA and lower BMI. These results provide evidence to focus on policies and structural supports for walkable/bikeable environments to supplement and enhance interventions encouraging individual behavior change for PA and weight management.

Development and validation of the Full Restaurant Evaluation Supporting a Healthy (FRESH) Dining Environment Audit

ABSTRACT The Full Restaurant Evaluation Supporting a Healthy (FRESH) Dining Environment Audit was developed and validated to assess cafeterias and restaurants (n = 362). Each scale item was scored using a 5-point semantic-differential rating (1 = little/no options/support to 5 = extensive options/high support for healthy food selection). Statistical analysis included factor analysis, analysis of variance, and correlations. The Healthfulness of Foods (HF) sub-scale assessed menu descriptions to determine healthful foods availability (12 items, α = .82, possible = 60). The Dining Environmental Supports (ES) sub-scale assessed nutrition information/labeling, signage/posters, and portion/cup sizes (eight items, α = .78; possible = 40). Cafeterias consistently scored higher than other restaurant types on HF (29.45 ± 12.17 SD) and ES (22.10 ± 5.27 SD). Convergent validity was confirmed (n = 91; HF: r = .854, p ≤ .001 and ES: r = .529, p ≤ .01). The FRESH audit is a simple tool that effectively assessed differences in the healthfulness of foods and environmental supports between a variety of dining venues.