Source: UNIV OF HAWAII submitted to NRP
MHEALTH TO IMPROVE DIET QUALITY AMONG ADOLESCENTS IN EFNEP IN HAWAII
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
ACTIVE
Funding Source
AFRI COMPETITIVE GRANT
Reporting Frequency
Annual
Accession No.
1029971
Grant No.
2023-67012-39409
Cumulative Award Amt.
$225,000.00
Proposal No.
2022-09708
Multistate No.
(N/A)
Project Start Date
Apr 1, 2023
Project End Date
Mar 31, 2026
Grant Year
2023
Program Code
[A1344]- Diet, Nutrition and the Prevention of Chronic Disease
Recipient Organization
UNIV OF HAWAII
3190 MAILE WAY
HONOLULU,HI 96822
Performing Department
(N/A)
Non Technical Summary
In collaboration with Drs. Corby Martin and John Apolzan, the Project Director (PD), Dr. Chloe Lozano, led the development and conducted preliminary evaluation of the PortionSize Ed mobile app at the Pennington Biomedical Research Center (PBRC), in Louisiana. PortionSize Ed is a dietary assessment and nutrition education app that provides real-time feedback to the user on adherence to personalized dietary recommendations. In collaboration with key stakeholders at the University of Hawaii (UH), Hawaii Extension, PBRC, and industry, the goals of this two year integrated extension and research Postdoctoral Fellowshipare to tailor PortionSize Ed for youth in the Hawaii Expanded Food and Nutrition Education Program (EFNEP), develop a modified EFNEP curriculum that facilitates the use of PortionSize Ed, and to test the feasibility, acceptability, and preliminary efficacy of integrating PortionSize Ed with EFNEP for improving diet quality among youth in Hawaii. Dr. Rachel Novotny at UH is the Primary Mentor, and Dr. Martin at PBRC is a Collaborating Mentor. The AFRI Farm Priority Area of this Postdoctoral Fellowship is food safety, nutrition, and health and it addresses food and nutrition translation. This research will build on the PD's experience in developing mHealth apps and delivering randomized controlled trials. The project supports one of EFNEP's key priority areas, which is to "strengthen science-based learning methods and enhance teaching techniques with appropriate new technologies, social media, and social-ecological approaches". Through the activities of this project, the PD will meet the requirements to be an independent researcher at UH.
Animal Health Component
0%
Research Effort Categories
Basic
100%
Applied
0%
Developmental
0%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
70360993020100%
Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
3020 - Education;
Goals / Objectives
This Postdoctoral Award will provide training and experience for the Project Director (PD), Dr. Chloe Lozano, to be an independent researcher at the University of Hawaii (UH) with research focused on mobile health (mHealth) and the prevention of childhood obesity. The PD is a dietitian with a Master's in Health Promotion and completeda Postdoctoral Research Fellowship at the Pennington Biomedical Research Center (PBRC) in the T-32 Training in Obesity Research program. During the PD's masters and doctoral training, she gained experience using a mobile food record to assess food waste of youth in a cross-sectional study in Hawaii, and for dietary intake of adults in a randomized controlled trial (RCT) in Hawaii. As part of her Postdoctoral Fellowship at PBRC, in collaboration with Drs. Corby Martin and John Apolzan, the PD led the development and conducted preliminary evaluation of the PortionSize Ed mobile app in Louisiana. PortionSize Ed, is a dietary assessment and nutrition education app that provides real-time feedback to the user on adherence to tailored US Department of Agriculture's (USDA) MyPlate food group recommendations. The development of PortionSize Ed was informed by the Theory of Planned Behavior (TPB).With support from key stakeholders, the objectives of this two year Integrated Extension and Research project are for the PD to 1) gain experience in developing an mHealth tool for improving diet quality among youth in the Hawaii Expanded Food and NutritionEducation Program (EFNEP), 2) Obtain skills in developing an EFNEP curriculum that includes mHealth, 3) Learn key policies and procedures of EFNEP evaluation, and 4) demonstrate competence in developing and managing an RCT pilot study aimed at testing the acceptability, feasibility and preliminary efficacy of coupling PortionSize Ed with EFNEP to improve diet quality among youth in Hawaii. This project supports one of EFNEP's key priority areas, which is to "strengthen science-based learning methods and enhance teaching techniques with appropriate new technologies, social media, and social-ecological approaches". This project builds on the PD's research experience. However, the PD's previous research primarily focused on adults, and she has not developed and delivered a RCT aimed at improving dietary behaviors among youth. Therefore, under the primary mentorship of Dr. Rachel Novotny, who is renowned for community-based childhood obesity research in the Pacific region, co-mentorship by Dr. Martin, a leading expert in mHealth research, and through activities proposed in this project, the PD will meet the requirements to be faculty at UH with research focused on mHealth and prevention of childhood obesity.
Project Methods
The current study is a 6-week cluster randomized design, with two study arms, 1) usual EFNEP for youth, (EFNEP), and 2) EFNEP integrated with the PortionSize Ed app (ENFEP-PSEd). The study will be delivered in one school on Kauai. The Extension Nutrition Educator on Kauai will deliver the EFNEP program to youth, which is the HI-FLY curriculum. Having a paraprofessional from the local community deliver EFNEP is a key part of the program. This study design will help ensure study results are transferable to the local community in Hawaii. Inclusion criteria include males or females, Grades 9 to 12 students attending the target school on Kauai, Hawaii, and there are no additional exclusion criteria. Parental consent and youth's assent will be required for study participation. The aim is to recruit at least 20 out of ~30 students from each classroom. However, this study can accommodate participation by the entire class. The two classrooms will be randomized to either EFNEP or EFNEP-PSEd. Participants will receive a $100 stipend at study completion. Study approval will be obtained through the Institutional Review Board at UH and will be registered with ClinicalTrials.gov.Since EFNEP is usually performed during regular class time, all children in the participating classrooms will receive the standard EFNEP program, and only participants enrolled in the study will undergo additional assessment measures. EFNEP usual care is the HI-FLY curriculum which includes 6 lessons of 1-2 hours each, over 6-weeks. Lesson topics include 1) food storage, safety, and sanitation practices, 2) enjoying more fruits and vegetables, 3) preparing and eating more meals at home, 4) choosing right-sized portions, 5) moving more every day and limiting screen time, and 6) re-thinking your drinks. For the EFNEP-PSEd group, participants will receive EFNEP usual care and be provided with a study smartphone for the 6-week study. Between each EFNEP session, participants will be asked to log their food intake in PortionSize Ed for ≥ one day, outside of school hours. PortionSize Ed data will be used during EFNEP to support goal setting. Participants will be directed to access the educational videos in PortionSize Ed, outside of school hours, to achieve learning outcomes.For all study participants, at baseline, trained study staff will administer a demographics questionnaire, the EFNEP Nutrition Education Survey, and collect weight and height measurements. The Nutrition Education Survey evaluates healthy eating behaviors, physical activity and reduced sedentary behavior, food safety behaviors, and beverages. If requested by the school, height and weight will be measured for all students in the classroom. Study staff will provide participants with a study smartphone and PortionSize Ed training. All participants will complete a one-day mobile food record, on a weekend day, using PortionSize Ed on the study smartphone provided. The Portion Summary tab and Videos tab in PortionSize Ed will be disabled and not visible to the participant when capturing their mobile food record, to reduce reactivity, and to capture usual dietary intake. The Portion Summary and Videos tabs will be re-activated during the intervention period to assist with healthy behavior change. Food images from the mobile food records will be analyzed using RFPM, to ensure minimal error in energy estimates, and each food item will be matched to FPEDs. HEI-2015 total scores an HEI-2015 component scores will be calculated from the FPED data. On completion of the study, baseline measures will be repeated. In addition, trained study staff will administer the Computer Systems Usability Questionnaire (CSUQ)and a User Satisfaction Survey (USS). The CSUQ has 19 questions, answered using a 7-point Likert scale, to rate overall satisfaction, usefulness, information quality and interface quality. The USS has nine quantitative questions, answered with a 6-point Likert scale, and rates satisfaction, ease of use, and adequacy of training. The USS also contains an open-ended question where participants can provide any additional comments. For the EFNEP-PSEd group, throughout the study, data will be collected on participants' usage of the PortionSize Ed app (e.g., number of meals logged, number of times the app was used).Continuous variables will be reported as mean ± SD or SEM, and categorical variables will be reported as counts and percentages. To assess feasibility, we will collect data on participation in the two study arms (EFNEP-PSEd and EFNEP), including the number of students who consent to participate and attrition rates over the 6-week study. To assess acceptability, we will summarize quantitative data and qualitative responses from the USS, and scores from the CSUQ. Any positive or negative experience from study participation will also be evaluated using qualitative responses from the USS, and by evaluating reasons for study dropout. Tracking food group intake is in line with DGA recommendations; therefore, we do not anticipate this intervention will negatively affect eating behaviors. We will also assess PortionSize Ed usage data. To assess preliminary efficacy, we will use intention-to-treat-analyses, where all individuals will be analyzed in a randomization group, regardless of compliance. A linear mixed model will be fit for each outcome. This model uses all available data to estimate the treatment effects over time using maximum likelihood estimation under a missing-at-random assumption. The model will include an indicator variable for intervention group (EFNEP vs. EFNEP-PSEd). The F test will be used to assess the intervention effect, defined as the contrast of change in EFNEP minus change in EFNEP-PSEd. Outcome variables include HEI-2015 score, HEI-2015 component scores, and healthy eating behavior score from the Nutrition Education Survey. Comparisons will be made between Week 6 vs. baseline for HEI-2015 scores, HEI-2015 component scores, and healthy eating behavior scores. Transformations will be made for non-normally distributed data. Diet data will be represented as group mean daily values. Per protocol analyses, for changes in diet quality will also be conducted only among those completing the intervention (i.e., had a Week 6 assessment). Statistical significance will be defined as p<0.05.Primary outcome measures: Feasibility: 1) at least 65% of students in each classroom enroll in the study, 2) No more than 15% study attrition. Acceptability: 1) USS scores and qualitative responses, 2) CSUQ scores, 3) PortionSize Ed usage data across the 6-week intervention, 4) reason for study drop out. Efficacy: 1) change in total HEI-2015 total score, HEI-2015 component scores, and healthy eating behavior scores between baseline and Week 6, 2) difference between change in total HEI-2015 total scores, HEI-2015 component scores, and healthy eating behavior scores between baseline and Week 6 for EFNEP vs. EFNEP-PSEd.

Progress 04/01/24 to 03/31/25

Outputs
Target Audience:During this reporting period, our project primarily targetedmiddle school students from aSNAP-Ed eligible school in Hawai'i, specifically grades 6-8. This group was selected due to their increased risk for diet-related chronic diseases and lower adherence to dietary guidelines. Adolescents were the focus of our intervention due to the developmental importance of this age group in forming lifelong eating habits, and the potential for scalable, early dietary interventions to support long-term health equity. Secondary target audiences included: SNAP-Ed Nutrition Educatorwho implemented the HI-FLY nutrition education curriculum in partnership with the research team. Teachers and school administratorswho supported implementation logistics and helped integrate app-based tools into existing classroom and health promotion activities. Parents and caregiversof participating students, who were informed about the study and received brief educational materials to reinforce learning at home. The statewide SNAP-Ed Hawai'iteam, who participated in ongoing dissemination, data interpretation discussions, and capacity-building efforts to adapt the intervention for broader use. These groups were reached through structured classroom instruction (HI-FLY lessons), in-person school visits, app-based experiential learning using the PortionSize Ed tool, and follow-up dissemination via school presentations and stakeholder meetings. Emphasis was placed on culturally relevant engagement, use of mobile technology for adolescent dietary tracking, and aligning nutrition messaging with SNAP-Ed priorities. This population remains a critical audience for nutrition equity efforts in Hawai'i. Our efforts during this period laid the groundwork for sustainable integration of mHealth dietary tools into school-based SNAP-Ed programs. Changes/Problems:No major changes were made to the project's overall design, research goals, or approved protocols during this reporting period. The study proceeded as planned, and there were no deviations from the approved data management plan, IRB protocol, or research timeline. However, through the implementation of the HI-FLY + PortionSize Ed pilot study, several lessons learned emerged that will help improve scalability and engagement in future iterations. These do not constitute problems or changes to the current approach but offer valuable insight for long-term planning. The most important lesson learned during this reporting period was the need for a web-based version of the PortionSize Ed app to increase accessibility across devices. A web-based platform would allow students to use the app on both personal smartphones andlaptops, helping to overcome barriers such asno-cellphone policies during class and the logistical burden of carrying a study-issued iPhone. Additionally, based on user feedback, we are working to enhance the usability of the app--particularly by improving the food search function to make logging entries faster and more intuitive for students. What opportunities for training and professional development has the project provided?This project provided important training and professional development opportunities for the Project Director (PD), an undergraduate student, a doctoral student, and community partners involved in the SNAP-Ed school-based pilot study. Project Director (Dr. Chloe Lozano) The USDA NIFA award supported the PD's transition from postdoctoral fellow to Assistant Professor at the University of Hawai'i Cancer Center. Key opportunities included: Mentorship from senior researchers in mHealth, childhood obesity, and community-based research: Drs. Rachel Novotny, Corby Martin, and John Apolzan. Leadership roles in professional societies, including Chair of the Nutrition Education and Behavior Science RIS at ASN and incoming Treasurer of the Digital Technology Division at SNEB. Acceptance of conference presentations at the ASN Nutrition2025 and SNEB annual meetings, where the PDwill presentproject findings and lead symposia focused on mHealth and youth nutrition. Training in human subjects research including IRB submissions, protocol development, and oversight of data collection in school-based settings. Capacity-building in mHealth technology integration, curriculum development, SNAP-Ed evaluation, and community engagement. Undergraduate Student (Emerald Proctor) Ms. Proctor conducted her senior undergraduate thesis under this project while enrolled in a joint Human Nutrition and Dietetics program between Trinity College Dublin and Technological University Dublin. Hands-on research experience in school-based dietary intervention, includingdata entry anddata analysis Authored a research thesis and developed foundational skills in community-based research and evaluation. Will presented project findingsat ASN Nutrition 2025 Doctoral Student (Dustin Valdez) Mr. Valdez, a PhD student in the Nutrition program at the University of Hawai'i at Manoa, received mentoring from the PD Professional development in project planning and proposal development SNAP-Ed Hawai'i Staff and Educators Participated in training on app use and classroom integration of mobile dietary tools. Co-delivered six nutrition lessons with the research team and provided feedback on curriculum enhancement. Developed new competencies in evaluating dietary behavior change using mHealth tools. Additional Development Activities All team members participated in internal study team workshops on mobile dietary assessment and SNAP-Ed-aligned behavior evaluation. Materials and processes developed for this study can informbroader training efforts for SNAP-Ed Hawai'i. How have the results been disseminated to communities of interest?This project actively disseminated results to communities who have a direct stake in the nutrition and health of youth in Hawai'i, with a focus on reaching underserved groups, local educators, and SNAP-Ed implementers. Efforts were made to increase awareness and understanding of the role that mobile health (mHealth) tools can play in supporting dietary behavior change among middle school students in SNAP-Ed-eligible schools. 1. School and Family Engagement Study results were shared directly with the participating school community, including teachers, administrators, and students. A parent-friendly summary report was created to explain study findings in accessible language and distributed via school contacts. The project team met with school leadership and SNAP-Ed coordinators to present results and discuss opportunities for continued collaboration. Teachers and administrators expressed strong interest in using mHealth tools again in future school-based programs. 2. SNAP-Ed Hawai'i Statewide Team Findings were presented to the full SNAP-Ed Hawai'i team, which includes program managers, nutrition educators, and stakeholders from each county. Results were shared during a statewide meeting to inform other educators about the feasibility and impact of pairing mobile tools with classroom nutrition education. The project sparked dialogue about expanding the use of culturally relevant technology in SNAP-Ed programs 3. Public and Professional Conferences The PD will be presentingthe results at the American Society for Nutrition (ASN) 2025 Annual Meeting during a featured symposium titled "Digital Tools to Promote Behavior and Diet Quality." This platform will helpdisseminate findings to national and international researchers and educators. The project will also be shared with attendees of the Society for Nutrition Education and Behavior (SNEB) Conference through the Digital Technology Division's symposium. 4. Undergraduate and Community Education The undergraduate thesis by Emerald Proctor was presented to her academic peers and faculty at Technological University Dublin and Trinity College Dublin, providing international visibility for community-engaged research. The PD and undergraduate researcher co-created materials that can be used to inspire other students to pursue community-based, applied research and health equity careers. 5. Public Understanding and STEM Engagement Through its presence in schools, this project introduced students to scientific concepts such as dietary tracking, behavior change theory, and real-time feedback technologies. Students and educators were exposed to how technology, science, and public health research intersect--enhancing interest in STEM-related careers and building skills in self-monitoring and data interpretation. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period, our primary focus will be on completing dissemination of findings, publishing study results, planning for scale-up, and addressing key challenges observed during the pilot trial. 1. Final Dissemination and Knowledge Translation Present findings at the American Society for Nutrition (ASN) 2025 Annual Meeting in the invited session Digital Tools to Promote Behavior and Diet Quality. Present findings at the Society for Nutrition Education and Behavior (SNEB) 2025 Annual Meeting, with additional outreach via the Digital Technology Division and SNAP-Ed networks. Submit the primary manuscript from the pilot randomized controlled trial for peer-reviewed publication, including dietary behavior outcomes and feasibility metrics. Continue sharing results with SNAP-Ed teams across the state through webinars, newsletters, and workshops to support broader implementation planning. 2. Scale-Up Planning and Curriculum Enhancement Use feedback from teachers and students to refine the PortionSize Ed app interface for youth users, particularly to improve ease of use and engagement inschool environments. Explore expansion of the HI-FLY + PortionSize Ed curriculum in partnership with additional schools and SNAP-Ed partners, including alignment with existing state nutrition education goals. 3. Professional Development and Mentorship Continue mentorship and research training for undergraduate and graduate students, with a focus on developing new grant proposals and manuscripts related to the current project. 4. Secure Additional Funding and Partnerships Submit a proposal for follow-up funding to expand the pilot into a multi-site RCT or implementation-effectiveness hybrid study. Deepen engagement with the Hawai'i State Department of Education and SNAP-Ed implementing agencies to co-design a pathway for institutional integration of mHealth tools in school wellness programs.

Impacts
What was accomplished under these goals? What is the problem this project addresses? Youth living incommunities with low-income often have poor diet quality and higher risk for obesity and related chronic diseases. Traditional SNAP-Ed lessons provide valuable nutrition education, but many students struggle to apply healthy eating principles outside the classroom. This project tested whether adding a mobile app (PortionSize Ed) to SNAP-Ed's school-based curriculum could help students make healthier food and beverage choices in their everyday lives. Who is helped and how? This work benefits SNAP-Ed-eligible students in grades 6-8 and the educators who deliver nutrition education. The study was conducted in partnership with SNAP-Ed Hawai'i and demonstrated that a mobile health (mHealth) tool can help reinforce nutrition concepts through real-time meal feedback. Students were engaged, and behavior changes were observed. The project also builds long-term capacity for digital SNAP-Ed tools and research expertise in underserved communities. Project Accomplishments by Goal Goal 1: Develop a tailored mHealth tool for youth in SNAP-Ed PortionSize Ed was customized with 6,556 USDA FNDDS foods plus 97 locally consumed foods not in the FNDDS database. The app allows users to photograph their meals and receive automated feedback based on USDA MyPlate goals. A web-based version of the appis also underdevelopmentto address challenges like cellphone restrictions in schools for future studies. Outcome: App development and data inclusion met target objectives. Goal 2: Create and deliver a curriculum combining mHealth with classroom instruction The HI-FLY (Hawai'i Food and Lifeskills for Youth) curriculum was delivered over 6 classroom sessions and co-taught with educators. The PortionSize Ed app was integrated to allow students to track meals, reflect on portion sizes, and set dietary goals alongside lesson topics. Outcome: Students reported that the app was no more burdensome than written food diaries and that it helped them reflect on their choices. Teachers supported the app's classroom use. Goal 3: Learn EFNEP/SNAP-Ed evaluation processes We used standardized SNAP-Ed-aligned tools to assess changes in dietary behavior. Surveys and app data were collected at baseline and 6 weeks post-intervention. The methods complied with SNAP-Ed evaluation procedures and were developed with input from SNAP-Ed Hawai'i leaders. Outcome: This approach ensured high-quality evaluation metrics and alignment with national EFNEP/SNAP-Ed practices. Goal 4: Conduct a pilot trial to test feasibility, acceptability, and outcomes A 6-week pilot studywas conducted in one Hawai'i middle school. Students were assigned to HI-FLY alone (n=22) or HI-FLY + PortionSize Ed (n=19). Outcomes included enrollment, app engagement, user satisfaction, and pre/post dietary behavior changes. Outcomes: Feasibility: 84% enrollment rate (42/50 students) Low attrition (2.4%) - only 1 student withdrew (unrelated to study) Acceptability: Students found the PortionSize Ed app acceptable and not more burdensome than written records Strong interest from teachers and SNAP-Ed staff Preliminary Outcomes - Youth Questionnaire results: ↓ Sugary drink intake in both groups: HI-FLY+PSEd: 3.36 → 2.83 (p = 0.004) HI-FLY: 3.37 → 3.01 (p = 0.03) ↑ Use of Nutrition Facts Labels (significant between groups): HI-FLY+PSEd: 2.39 → 3.23 (p < 0.001) HI-FLY: 2.48 → 2.57 (p = 0.68) p between groups = 0.02 ↑ Healthier food choices when eating out: HI-FLY+PSEd: 2.27 → 2.60 (p = 0.28) HI-FLY: 2.24 → 2.87 (p = 0.03) HEI-2020 Results: No significant changes in Healthy Eating Index scores in either group HI-FLY+PSEd: 45.1 → 40.7 HI-FLY: 41.3 → 45.6 Why this matters This study confirmed that integrating a mobile app into SNAP-Ed nutrition education is both feasible and acceptable. While diet quality scores (HEI-2020) didn't significantly change, there were positive shifts in nutrition behaviors, especially among students using the app. Increases in food label use and reduced sugary drink consumption are meaningful steps toward long-term health improvement. This project also strengthened community-university partnerships and laid the foundation for a larger, more powered study. The results support expansion of tech-enhanced SNAP-Ed programs and highlight the importance of tools that are both culturally tailored and accessible.

Publications


    Progress 04/01/23 to 03/31/24

    Outputs
    Target Audience:Target audience(s): Children and adolescents Community and school-basededucators Efforts: Conference presentations Nutrition education videos for extension and outreach Workshops Experiential learning opportunities Development of novel dietary assessment methods Laboratory instruction Conference presentations Changes/Problems:The major changes include working with SNAP-Ed instead of EFNEP and early adolescents instead of adolescents. Working with SNAP-Ed instead of EFNEP: Rationale for change: The PD works closely with the Hawaii EFNEP and SNAP-Ed Director, Dr. Jeannie Butel. Dr. Butel advised the PD that it would be better to work with SNAP-Ed to deliver the pilot study in Kauai because there is no EFNEP in Kauai. Both EFNEP and SNAP-Ed deliver the Hawaii Food and Lifeskills for Youth (HI-FLY) curriculum, which will be used during this pilot study. Therefore, changing from working with EFNEP to SNAP-Ed does not affect the study design. Working with early adolescents instead of adolescents: Rationale for change:The School Principal in Kauai advised the PDthat it would be better to work with Grades 6-8 students and not those in Grades 9-12. This is because the Grades 9-12 students will be busy focusing on their exams and will have less time to dedicate to this pilot study. What opportunities for training and professional development has the project provided?This NIFA Postdoc has provided the PD with ample training and professional development. To assist with tailoring the PortionSize Ed food database for youth in Hawaii, the PD was trained on the development and application of the Pacific Tracker (PacTrac). Dr. Novotny developed the PacTrac dietary assessment program for evaluation of dietary data for the Pacific Islands. The PD also attended weekly CHL(Children's Healthy Living)Research Group meetings with Dr. Novotny to assist with training on delivering a childhood obesity prevention program in Hawaii. To create culturally appropriate nutritional educational videos for Hawaii SNAP-Ed youth, the PD worked closely with the Hawaii SNAP-Ed Program Director, SNAP-Ed Program Coordinator, and SNAP-Ed Nutrition Educator. The PD was also trained in the delivery of SNAP-Ed classes to children in Hawaii and shadowed the delivery of SNAP-Ed in a classroom. With support from Dr. Butel, the PD was trained in SNAP-Ed policies and procedures, including program implementation, and evaluation guidelines. The PD has also met monthly with her collaborating mentor, Dr. Corby Martin for training in developing mHealth technologies and delivering RCTs. The PD also audited a coding class at the University of Hawaii in SAS and R coding, to ensure she could score diet quality (HEI-2020) at the completion of the study. The PD also developed professionally by hiring and managing a Research Assistant. The Research Assistant was hired at the beginning of this study and continues to provide important research assistance. Overall, the PD has become more competent as an independent researcher in Hawaii. How have the results been disseminated to communities of interest?The study will begin in August 2024; therefore, the primary results are not yet available to disseminate to the community. What do you plan to do during the next reporting period to accomplish the goals?In the next reporting period we will finalize the study recruitment, deliver the RCT pilot, conduct data collection, analyze study data, publish the study results in a peer-reviewed journal, and use the pilot data to apply for another research grant.

    Impacts
    What was accomplished under these goals? In the last 12 months the PD led the development of the PortionSize Ed app for SNAP-Ed Hawaii. We had originally planned to work with EFNEP; however, with guidance from the Hawaii EFNEP and SNAP-Ed Program Director, we changed to working with SNAP-Ed. To create the PortionSize Ed app multiple steps were needed including, development of a nutrient database, development of nutrition education videos, visual design of the PortionSize Ed app, and creating a PortionSize Ed app tutorial. Each of these components were tailored for children in Hawaii. In addition, we developed a web-based platform for receiving and analyzing all PortionSize Ed data, and conducted continuous in-lab testing of the app. Further details are provided on these steps below: Development of a nutrient database for PortionSize Ed: A dataset of 1,858 commonly consumed foods in Hawaii was compiled from dietary studies conducted at the University of Hawaii (UH) at Manoa and the UH Cancer Center. Using this dataset, the PD identified 97 foods not found in FNDDS (version 17-18). These 97 foods were 1) matched to the closest match in FNDDS if they were single item foods, and 2) using recipes, broken down into ingredients and matched to FNDDS ingredients codes (version 17-18). These 97 foods were then added into the PortionSize Ed app, in addition to 6,556 foods from FNDDS (version 17-18) that are consumed by children (e.g. excluded alcohol and baby foods). Therefore, each food in PortionSize Ed is linked to a FNDDS code and diet quality (HEI-2020 scores) can be calculated from the data output. Development of nutrition education videos: Seven nutrition education videos were developed with the assistance of the Distance Education team at the University of Hawaii at Manoa. These videos include 1) Meet MyPlate, 2) MyPlate: Protein, 3) MyPlate: Vegetables, 4) MyPlate: Fruits, 5) MyPlate: Grains, 6) MyPlate: Dairy, 7) Understanding Nutrition Labels. Each video is less than 3 minutes in duration and featured foods commonly consumed in Hawaii (e.g. taro, papaya, hapa rice). Each video also contains subtitles. The videos are embedded into the PortionSize Ed app, under the "Videos" tab, are available through YouTube, and are also featured on the University of HawaiiNutrition Center website. Visual design of the PortionSize Ed app: The PortionSize Ed app was designed to be appropriate for children. Therefore, the Portion Summary screen provides tailored feedback on intake of Fruits, Vegetables, Dairy, Grains, and Protein, Saturated Fat and Added Sugar, but does not provide feedback on intake of alcohol or energy (kcal).Alcohol should not be consumed by children, and it is recommended that children focus on meeting food group requirements. Creating a PortionSize Ed app tutorial: A PortionSize Ed app tutorial was created and embedded into the app. This tutorial is also available through YouTube.The tutorial was designed so that users could re-train how to use the PortionSize Ed app when needed. Obtain skills in developing an EFNEP curriculum that includes mHealth: Given we changed to working with the SNAP-Ed program, the PD developed skills in developing SNAP-Ed curriculum that includes mHealth. The standard SNAP-Ed curriculum will be provided to all study participants. For the experimental group, who receives the PortionSize Ed app, they will also be provided with a Portion Summary Worksheet and a SMART Goals Worksheet. After participants have recorded their intake using the PortionSize Ed app, they will transfer the information from the Portion Summary screen into the hard copy Portion Summary Worksheet. This information will then be used to set SMART goals. For example, if a participant only consumes one instead of the recommended two cup eq. of Fruits for the day, they could use the SMART goals worksheet to problem solve how to consume two cup eq. of Fruits by the next SNAP-Ed lesson in one week. Learn key policies and procedures of EFNEP evaluation: Instead of EFNEP, the PD learned about key policies and procedures for SNAP-Ed evaluation. Given the PD target group is children, she was trained on delivering and evaluating SNAP-Ed for children in Hawaii. This training was provided by the SNAP-Ed Program Director, SNAP-Ed Program Coordinator, and SNAP-Ed Nutrition Educator in Hawaii. Training was provided online and in person. The PD also observed a final SNAP-Ed session, including completion of the SNAP-Ed Nutrition Education Survey by participants. Demonstrate competence in developing and managing an RCT pilot study aimed at testing the acceptability, feasibility and preliminary efficacy of coupling PortionSize Ed with EFNEP to improve diet quality among youth in Hawaii: The PD has demonstrated competence in these areas by developing the pilot study protocol, study questionnaires, study flyer, consent and assent forms, registering the study on ClincalTrials.gov, receiving IRB approval, building the PortionSize Ed app, managing the study budget, hiring, supervision and training of a Research Assistant, delivering recruitment sessions at the target school, and establishing partnerships with key community stakeholders. The PortionSize Ed pilot study will begin at the end of August; therefore, the PD will report on her competence on delivering the RCT in the next progress report.

    Publications

    • Type: Conference Papers and Presentations Status: Other Year Published: 2023 Citation: https://www.usp.ac.fj/the-institute-of-applied-sciences/11th-oceania-foods-2023/
    • Type: Journal Articles Status: Published Year Published: 2023 Citation: Lozano CP, Canty EN, Saha S, Broyles ST, Beyl RA, Apolzan JW, Martin CK. Validity of an Artificial Intelligence-Based Application to Identify Foods and Estimate Energy Intake Among Adults: A Pilot Study. Curr Dev Nutr. 2023 Sep 29;7(11):102009. doi: 10.1016/j.cdnut.2023.102009. PMID: 38026571; PMCID: PMC10656219.
    • Type: Journal Articles Status: Accepted Year Published: 2024 Citation: Validity of the PortionSize app compared to MyFitnessPal for estimating intake: A randomized crossover laboratory-based evaluation (in print in AJCN).
    • Type: Conference Papers and Presentations Status: Accepted Year Published: 2024 Citation: A Food and Nutrient Database for Dietary Studies (FNDDS) Tailored to Hawaii May Reduce Dietary Assessment Error