Makenzie Barr

Ripple Effect Mapping Outcomes of a Childhood Obesity Prevention Program From Youth and Adult Dyads Using a Qualitative Approach: iCook 4-H

Objective: To describe the impact of the iCook 4‐H intervention study based on data gathered through ripple effect mapping focus groups through an explorative approach. Design: Youth–adult dyads responded about ways in which iCook had affected the individual, family, and community. Three questions were asked: (1) What were people doing differently as a result of iCook? (2) Who benefited from iCook and how? (3) Were there changes in the way community groups and institutions did things as a result of iCook? Setting: Ripple effect mapping sessions took place across 5 states (Maine, Nebraska, South Dakota, Tennessee, and West Virginia). Participants: Seventy dyad participants (n = 35 youth, n = 35 adults) from the iCook 4‐H intervention. Main Outcome Measure: Three core themes of iCook 4‐H were assessed: cooking, eating, and playing together. Analysis: Direct content analysis and word frequencies were used. Results: Seven categories emerged: improved health, increased community involvement, increased knowledge, increased communication, changed motivation, financial mindfulness, and increased appreciation for family. An overarching theme that was determined was that learning new skills together through trying new things (cooking, eating, and playing) leads to positive individual family and community change. Conclusions and Implications: Ripple effect mapping was effective in determining the perceived impact of iCook 4‐H on oneself, family, and community.

Health Behaviors of Student Community Research Partners When Designing and Implementing a Healthy Lifestyle Intervention on College Campuses

Few studies work with college students as equal partners in all aspects of Community-Based Participatory Research (CBPR) and even less evaluate behaviors of those college partners. The current study aimed to examine health behaviors of students by designing and implementing a peer-led, social marketing campaign (Get Fruved) to promote healthier lifestyles on their campuses. Enrolled students (n = 376) were trained to either design and implement a health promotion intervention (Social Marketing and Environmental Interventionists; SMEI, n = 78), be peer mentors (PM; n = 205), or serve as control participants (n = 93). Students’ behaviors (dietary, activity, and stress) and anthropometrics were assessed at baseline, 6 months, and 12 months. The population was predominately Caucasian, female, and between 19 and 20 years old. On average, fruit and vegetable consumption slightly decreased across all time points for each group with control at a larger decline. Students International Physical Activity Questionnaire (IPAQ) scores showed students met recommended amounts of activity throughout the intervention, with males reporting higher activity levels. Cohen’s Perceived Stress Scale (PSS) analyses indicated 19 year olds had higher stress along with females had higher than males. Students involved in a CBPR approach to be trained, design, and implement a lifestyle intervention can achieve maintenance of health behaviors throughout a college year when compared to control students.

Shortening of the Pittsburgh Sleep Quality Index Survey Using Factor Analysis

Objective/Introduction Lengthy surveys have the potential to burden users and can lead to inaccuracies. Conducting analyses to shorten existing validated surveys is beneficial. The objective, therefore, was to shorten the Pittsburgh Quality Sleep Index (PSQI) for young adults. Methods PSQI data from 1246 college students were used. An exploratory factor analysis (FA) was utilized to shorten survey after dropping select items. Nonparametric correlation analysis (Spearmans rho) was conducted between the global sleep scores of the shortened and original surveys. Agreements tests (Kappa and McNemars test) measured the agreement of the surveys and sensitivity and specificity were evaluated. Results Six factors were examined using maximum likelihood factoring method, applying squared multiple correlations with Promax rotation to allow for correlated variables. FA with six factors explained 100% of shared variance based on eigenvalues and accounted for 61% of variability based on variables. The FA resulted in 13 selected questions (“shortPSQI”), corresponding to 5 of the 7 components of the original survey. High correlation was found between the global scores of the original survey and the “shortPSQI” (rho = 0.94, p < 0.001). When the global score was converted to the categorical variable of good or poor sleepers, the agreement test indicated strong agreement (Kappa 0.83, 95% CI 0.79–0.86, p < 0.0001). Conclusion The validated, 19-item PSQI survey was shortened to 13 items. Tests of correlation and agreement indicate the “shortPSQI” may be an acceptable alternative to the original survey for young adults. Clinical Trial Registration Data for this study was taken from the Get Fruved study, registered on October 21, 2016, on clinicaltrials.gov (NCT02941497).

eB4CAST: An Evidence-Based Tool to Promote Dissemination and Implementation in Community-Based, Public Health Research

eB4CAST, evidence-Based forecast C-capture, A-assemble, S-sustain, T-timelessness (eB4CAST), framework was developed from existing dissemination and implementation (D & I) constructs as a dissemination tool to promote community-based program usability and future application in targeted populations. eB4CAST captures and transforms research findings into a dissemination report that shows program need and impact to endorse program continuation and expansion. This is achieved through direct and indirect data collection of community factors and program impact that can showcase the need for program sustainability and potential for future dissemination sites. Testimonials, individual feedback, and program process and outcomes contribute to the direct data while data collected from census, county, and state databases and reports allow for indirect information to be captured and analyzed. Capturing data in the two levels allow eB4CAST to forecast program need and highlight program impact through a footprint. eB4CAST framework for dissemination tool creation is organized into four sections: Capture, Assemble, Sustainability, and Timelessness. Capture encompasses the collection of indirect and direct data related to intervention goals. Assemble is the compilation of the data into a visually appealing and easily understood media. Sustainability encourages the use of dissemination tools to provide forecast of program need and footprint of program impact back to community participants, program leaders, and key stakeholders to endorse program sustainability. Lastly, timelessness encourages cyclic movement through these constructs to continue program monitoring and data sharing to ensure timeless program evaluation and conformation to change in needs. The eB4CAST framework provides a systematic method to capture justification of program need and impact of community-based research that can be modified to fit diverse public health interventions providing a necessary D & I tool.

Development of iGrow: A curriculum for youth/adult dyads to increase gardening skills, culinary competence, and family meal time for youths and their adult caregivers

This manuscript describes the development of a “learn by actively participating” curriculum for youth and their adult caregivers (dyad pair) to increase gardening skills, culinary competence, and family meal time. The curriculum was developed by integrating “iCook 4-H” and Junior Masters Gardener “Health and Nutrition from the Garden”, and “Essential Elements of 4-H Youth Development” curriculums with additional resources for gardening activities from the USDA’s My Plate and garden-based recipes. Expert reviewers (n = 11) provided feedback on the curriculum content, session structure, dosage, age appropriateness, and balance of the three focused areas. Seven family dyads (n = 14) participated in focus groups about understanding of need, interest, barriers, and potential engagement. A 10-week curriculum was developed and named: iGrow. The curriculum is a hands on, active learning program delivered through five, two-hour sessions using a family dyad model. Three main focus areas included gardening, culinary skills, and family conversation/interaction that all focused on togetherness. For the final iGrow curriculum, expert-level content review and feedback from focus group dyad pairs was used to revise the curriculum which further enhanced the approach and balance of the curriculum content. Focus group feedback supported appropriateness, dosage and learning objectives, and content depth. This curriculum has been developed to provide knowledge of gardening and culinary skills with the goal of increased consumption of fruit and vegetables.

Neck Circumference Positively Relates to Cardiovascular Risk Factors in College Students

The objective of this study was to determine the relationship between neck circumference (NC) and other anthropometric measures and examine cut-off points for males and females according to existing waist circumference cut-off levels in this age group. Across 8 universities, 1562 students underwent a physical assessment. Spearman rho correlations (ρ) were calculated to determine associations between NC and other continuous variables of health. Receiving operating characteristic curves were constructed to assess the optimal cut-off levels of NC of males and females with central obesity. Participants were predominantly Caucasian (67%), female (70%), and outside of Appalachia (82%). Forty-one percent of males and 34% of females had a BMI ≥ 25 kg/m2. In both sexes, significant positive correlations were seen between NC and body weight, BMI, waist circumference, hip circumference, and systolic blood pressure (all p-values < 0.0001). NC ≥ 38 cm for males and ≥33.5 cm for females were the optimal cut-off values to determine subjects with central obesity. NC has been identified to closely correlate with other anthropometric measurements related to disease and could be used as a convenient, low-cost, and noninvasive measurement in large-scale studies.

Self-Reported vs. Measured Height, Weight, and BMI in Young Adults

Self-reported height and weight, if accurate, provide a simple and economical method to track changes in body weight over time. Literature suggests adults tend to under-report their own weight and that the gap between self-reported weight and actual weight increases with obesity. This study investigates the extent of discrepancy in self-reported height, weight, and subsequent Body Mass Index (BMI) versus actual measurements in young adults. Physically measured and self-reported height and weight were taken from 1562 students. Male students marginally overestimated height, while females were closer to target. Males, on average, closely self-reported weight. Self-reported anthropometrics remained statistically correlated to actual measures in both sexes. Categorical variables of calculated BMI from both self-reported and actual height and weight resulted in significant agreement for both sexes. Researcher measured BMI (via anthropometric height and weight) and sex were both found to have association with self-reported weight while only sex was related to height difference. Regression examining weight difference and BMI was significant, specifically with a negative slope indicating increased BMI led to increased underestimation of weight in both sexes. This study suggests self-reported anthropometric measurements in young adults can be used to calculate BMI for weight classification purposes. Further investigation is needed to better assess self-reported vs measured height and weight discrepancies across populations.

Health Disparities Score Composite of Youth and Parent Dyads from an Obesity Prevention Intervention: iCook 4-H

iCook 4-H is a lifestyle intervention to improve diet, physical activity and mealtime behavior. Control and treatment dyads (adult primary meal preparer and a 9–10-year-old youth) completed surveys at baseline and 4, 12, and 24 months. A Health Disparity (HD) score composite was developed utilizing a series of 12 questions (maximum score = 12 with a higher score indicating a more severe health disparity). Questions came from the USDA short form U.S. Household Food Security Survey (5), participation in food assistance programs (1), food behavior (2), level of adult education completed (1), marital status (1), and race (1 adult and 1 child). There were 228 dyads (control n = 77; treatment n = 151) enrolled in the iCook 4-H study. Baseline HD scores were 3.00 ± 2.56 among control dyads and 2.97 ± 2.91 among treatment dyads, p = 0.6632. There was a significant decline in the HD score of the treatment group from baseline to 12 months (p = 0.0047) and baseline to 24 months (p = 0.0354). A treatment by 12-month time interaction was found (baseline mean 2.97 ± 2.91 vs. 12-month mean 1.78 ± 2.31; p = 0.0406). This study shows that behavioral change interventions for youth and adults can help improve factors that impact health equity; although, further research is needed to validate this HD score as a measure of health disparities across time.

Correlations of Self-Reported Androgen Deficiency in Ageing Males (ADAM) with Stress and Sleep among Young Adult Males

Androgen deficiency in males has traditionally been predominantly limited to older men aged 50+ years. However, little is known of the correlation between hormonal disruption, stress, and sleep in college-aged males. This cross-sectional study investigates lifestyle behavior patterns in young men and a screening for potential androgen deficiency. A survey of 409 male students, as part of a larger USDA-funded GetFruved study, was analyzed for this subproject. Survey instruments used include the Androgen Deficiency in the Aging Male Questionnaire (ADAM) to assess for inadequate ADAM scores, the Perceived Stress Scale to measure stress levels and the Pittsburgh Sleep Quality Index to evaluate sleep quality. In total, 144 male participants (35%) met criteria for potential androgen deficiency defined by the ADAM questionnaire. Correlation was found between having a positive ADAM score and both increased stress levels (p < 0.001) and poor sleep quality (p < 0.001), with stress displaying the strongest effect (p < 0.001 vs p = 0.124). An increased prevalence of having a positive ADAM score versus established norms for this age group was also noted. These findings highlight the need for investigation of endocrine disruptions in young men.