Source: UNIV OF CONNECTICUT submitted to
EFFECTIVENESS OF AN IMB-BASED INTERVENTION FOR REDUCING SWEETENED BEVERAGE CONSUMPTION IN PRESCHOOL CHILDREN
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
TERMINATED
Funding Source
NRI COMPETITIVE GRANT
Reporting Frequency
Annual
Accession No.
0213665
Grant No.
2008-55215-19071
Project No.
CONS2007-04586
Proposal No.
2007-04586
Multistate No.
(N/A)
Program Code
31.5
Project Start Date
Jul 1, 2008
Project End Date
Jun 30, 2013
Grant Year
2008
Project Director
Ferris, A. G.
Recipient Organization
UNIV OF CONNECTICUT
(N/A)
STORRS,CT 06269
Performing Department
MEDICINE
Non Technical Summary
Sweetened beverages and over consumption of 100% fruit juice (SBC) add unneeded calories to diets in young children, potentially leading to overweight. As children's diets are extensions of their parents' behaviors, we propose to implement a nutrition education intervention based on the Information-Motivation-Behavioral Skills (IMB) behavior change model using parents as the primary agent of change. This integrated project's goals are to evaluate an intervention for reducing SBC in minority preschool children from low-resource families (research), assess the impact of this research-based program in nutrition education activities (extension), and enhance undergraduate cultural competency through a service-learning program (education). The proposed research uses a randomized control group design involving 20 parents of 3-5 year olds at 20 sites (n=400) over 3 years. We will randomly assign sites to two experimental conditions: 1) 10-week SBC education intervention and 2) 10 week SBC-unrelated sham education control. Data collection for the two groups will be conducted at baseline and 1 week and 6 months post-intervention. Measures to be collected include IMB survey, home beverage inventory, weekend food recall, and anthropometrics. Short, interactive education experiences will be available to all parents. Each semester 8 students (n=32) will enroll in an experimental course aimed at increasing students' cultural competency. For 10 weeks, students will attend classroom training and spend 2 hours twice a week at sites implementing the nutrition education program. In summary, this program will decrease SBC in preschool children, provide a sustainable and realistic extension program for community preschools, and increase the number of culturally competent, community-based nutrition education professionals as a result of their participation in this program.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
90%
Developmental
10%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7036020101010%
7036020302040%
7036020303030%
7036020307020%
Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
6020 - The family and its members;

Field Of Science
3020 - Education; 1010 - Nutrition and metabolism; 3030 - Information and communication; 3070 - Psychology;
Goals / Objectives
Prevention of overweight should begin during early childhood when the development of eating habits begins. Yet, fourteen percent of U.S. preschoolers are already overweight, with minority children and children from low-income families more likely to be overweight. Thus, these children are moving into adulthood with poorly developed strategies to achieve or maintain a healthy weight. One dietary component currently receiving attention is beverage intake. Preschool children are drinking more soda, fruit drinks, and other sweetened beverages than ever before. This sweetened beverage consumption and over consumption of 100% fruit juice consumption (SBC) is positively associated with calorie intake and potentially contributes to childhood overweight. Ultimately, reducing calories by reducing SBC may foster the development of a healthy eating lifestyle that children can continue into adulthood. During the preschool years, parents must be the focus of nutrition education behavior change interventions as they are the food gatekeepers. To date, the nutrition education community has not embraced a single model as the gold standard for behavior change. We chose the Information-Motivation-Behavioral Skills (IMB) model, a model that includes highly generalizable constructs, is applicable to almost any health-related behavior, and allows researchers to delineate how the separate and cumulative effects of parental information, motivation, and behavioral skills influences the desired health outcome. The goals of the planned project are to: 1)evaluate an IMB-based intervention for reducing calories from SBC in 3-5 year old, minority children from low-resource families using parents as the primary agent of change (research), 2) assess the impact of this research based program in established nutrition education activities (extension), and 3)enhance undergraduate cultural competency and leadership skills through a service-learning program coupled with this research/extension project (education).
Project Methods
The efficacy of the Information Motivation Behavior (IMB) model articulated to child sweetened beverage consumption (SBC) will be assessed using a randomized, pretest-posttest control group design involving approximately 400 primary caretakers of 3-5 year olds in 20 preschool programs for low income children over a 3 year period. These sites will be randomly assigned to two experimental conditions. Ten sites will receive a 10-week sweetened beverage consumption (SBC) education intervention and ten sites will be assigned to the control group and will receive 10 weeks of alternative nutrition education not related to SBC. Data collection for the two groups will be conducted at baseline (prior to education implementation) and at 1 week and 6 months post-intervention. Participants in the intervention will receive 10 weeks of SBC-related nutrition education at the preschool or daycare of their child. Each week, during the afternoon pick-up time, two student educators and staff will deliver a different lesson pertaining to parental information, motivation, or behavioral skills related to SBC. While learning experiences may be different in each circumstance, this form of education is more realistic and sustainable than interventions that only allow for one-on-one teaching, requiring participants to wait or schedule an appointment. Procedures used to collect data from parents and children will be identical across all 3 time points and among sites. At each point, two periods of data collection will occur: 1) at a prearranged meeting at the day care, researchers will take anthropometric measurements, administer the IMB, Parent Attitude Toward Nutrition and Child Health, and Food Security questionnaires, and train the parent on the food record and home beverage inventory (HBI); 2) on the following Monday, the researcher will call the parent to collect data from the HBI and conduct the 48 hour food recall aided by the food record. Because this study utilizes a randomized multisite design in which participants are nested within daycare sites, scientific tests of the effectiveness of the intervention will be performed in a series of regression models using SUDAAN. The research team will complete a process evaluation currently in place for the University of Connecticut Food Stamp Nutrition Education Program for the Extension portion of this proposal. An experiential course at the University of Connecticut is incorporated in this project. Thirty-two students from the University of Connecticut will enroll in a ten week experiential course, Husky Nutrition, aimed at increasing student cultural competency and leadership skills. For ten weeks, students will attend a 1-hour classroom training and spend 4 hours at their assigned site with their student partner, implementing nutrition education programming and the research intervention. The evaluators will use instruments tested in a USDA Higher Education Challenge Grant and rigorous qualitative procedures.

Progress 07/01/08 to 06/30/13

Outputs
Target Audience: The final year of the project did not include any data collection. However, this project successfully reached it target audiences of low-income, parents of pre-school children and undergraduate students. Research/Extension: Four hundred and sixty-one parent/child dyads participated in the study. Mean age of parents was 31.5±7.2 years. Caregivers were predominantly female and fewer than half were married/partnered. One-third of the caregivers self-identified as Latino and 45% self-identified as Black (African, African American, West Indian). The majority of the participants were employed (70%) and had at least a high school education (90%). More than 75% of participants were overweight (34%) or obese (43%). Forty-five per cent currently participated in SNAP and 35% currently participated in WIC and a majority of families were food secure (55% high, 19% marginal, 21% low, and 5% very low). The average age of their children was 4.2 yrs. + 0.65. Parents identified the children as Latino (33%), black (African-American, Africa, West Indian (45%), white (17%), or other (5%). Forty-seven per cent were female with a disproportionate percent of the sample classified as overweight or obese (3% underweight, 64% normal, 19% overweight, and 14% obese). Education: One hundred and thirty eight University of Connecticut students (8 freshman, 32 sophomores, 44 juniors, 47 seniors, and 7 post graduate) participated in the project. Participating students were from a wide variety of majors with 79 from the College of Agriculture and Natural Resources, 44 from Liberal Arts and Sciences, 5 from Neag School of Education, 5 from Business, 3 from Nursing, and 2 from School of Pharmacy. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? This project provided a post-doctoral traineeship to Karina Lora, now an assistant professor at the University of Oklahoma Health Sciences Center and doctoral training to Ailton S. Coleman, a UCONN minority scholar and David Glenn, doctoral student in public health. Mr. Coleman's dissertation is evolving from this work. Three masters plan A theses were part of the work plan for the project. Katherine Kuzmekas, M.P.H., and S. Wei and L. Drake, M.S. in Nutritional Sciences. In addition, one fourth year medical student, Kerrie Ann Hudson completed a research rotation, “Parent Perceptions of Messages Delivered by University Students” that was part of a paper published by the group. A. Ferris was the major advisor or primary mentor for all of the trainees. In addition, 104 students earned two academic credits in the service learning course associated with this grant and 34 students participated in a paid summer “Husky Scholars” internship program. Part of the experience for the internship program was to deliver the education program related to this grant. How have the results been disseminated to communities of interest? As outline in the original proposal, once the data collection period ended, we started presenting key findings to our key stakeholders. In particular, we focused our progress reports on the 66 early childhood education centers licensed in the city of Hartford. That interaction has led to major initiatives by the city including a randomized survey of child weight that resulted in the Mayor’s Task Force on Childhood Obesity and subsequent evaluation of food and nutrition policies in the early child care centers in Hartford, CT. Presentations to parents and caregivers are now coordinated with other efforts in the city. In addition, we have made several presentations at the annual meetings of the Society for Nutrition Education and Behavior, American Society for Nutrition, the American Public Health Association, and the Academy of Dietetics and Nutrition. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Goal One: Evaluate an IMB-based intervention for reducing calories from sugar-sweetened beverages in 3-5 year old minority children from low-resource families using parents as the agents of change. The completion of this goal first required extensive instrument development and protocol testing. The researchers developed and extensively tested a survey instrument to measure change in information, motivation, and behavioral skills and assess the relationship between these constructs and the main outcome measure: sugar-sweetened beverages., a validated inventory instrument to assess beverages in home, and adapted and tested a measure of parental feeding practices. In addition, carefully messaged and tested curricula with ten lessons focused on reducing sugar-sweetened beverages for the intervention group and home for safety for the control group was developed. The curricula supported the severe time constraints of the parents and expected weekly interaction during an educational session to be less than one minute for ten weeks. The group then recruited over 500 meeting parents and children from 24 pre-school sites in greater Hartford, CT. As noted under the target audience section of this report, all were low-income and predominantly minority parents. The research team then followed four hundred and seventy-one of these parent/child dyads for six months with extensive behavioral, dietary, and anthropometric data collected at baseline, immediately post-intervention, and three months later to assess sustainability. At the time of this report, the model of the contribution and relationship of the information, motivation, and behavioral skills constructs to the reduction in sugar-sweetened beverages was not fully developed. In summary, this brief intervention resulted in a significant reduction in sugar-sweetened beverage home inventory for the child, amount consumed by the child as measured by a food frequency based on the home inventory, and two-days of weekend food records for individuals receiving SNAP benefits. Beverages in the home: Over 3500 distinct beverages, grouped into 16 categories, were present in the homes of study participants. Total milk (23.4%) and fruit juice (21.2%) made up the highest volume of beverages available in the home of participants, followed by bottled water (17.2%), juice drinks (17.1%), iced tea (8.3%), regular soda (7.6%), low calorie-beverages (4.3%) and sports/energy/and nutritional supplements (5%). The composition of beverages available in the home for the caregiver was different than for the child. The proportions of milk (p<0.0001) and fruit juice (p<0.0001) in the caregiver inventory were half of the proportion in child inventory. Also, regular soda (p<0.0001) accounted for only 2.8% of the child’s inventory, but was almost one quarter of the caregiver inventory. Bottled water (p<0.0001) and juice drinks (p<0.0001) accounted for larger proportion of the child’s inventory, but the proportion of iced tea (p=0.005) and low-calorie beverages (p<0.0001) was larger in the caregiver’s inventory. Intervention and child consumption. Child consumption derived from a food frequency from the home inventory (HBI) and two days of weekend food records at each of the three study time points provided the metric for child consumption of beverages during the study. Based on the HBI data, non-parametric tests showed no difference in ounces available (median (min, max) 349 (6, 2442) and 282 (6, 8524)) or ounces of daily child consumption (10 (1, 106) and 12 (1, 62)) for control and intervention groups, respectively, at baseline. At 6 months, both groups showed a significant (p<0.02) decrease in oz. child consumed/d (control: 6.2 [0, 48], intervention: 2.9 [0, 53]); the difference between the groups neared significance (p=0.06). In contrast, there was no decrease in total amount of sugar-sweetened beverages for the whole family in the home. Preliminary results show a decrease in child daily consumption of SSBs without a corresponding decrease in HBI. The analyses with food records told a similar story with no differences in ounces of daily child consumption (7.5 (0, 31.8) and 8.9 (1, 676.8)) for control and intervention groups, respectively, at baseline. At 6 months, neither group showed a significant decrease in oz. child consumed/d (control: 8.5 [0, 32.9], intervention: 7.9 [0, 28.9]); there was no difference between the groups (p=0.34). However, among SNAP recipients, consumption of SSBs in the intervention group was significantly different than the control group (p=0.03). In fact, 21.7% of the participants in the intervention group reported consuming < 1oz/day compared to only 8.8% in the control group. We examined the correlation between food record consumption and consumption reported by parents as part of the HBI data. Ounces consumed (r=.33), total sugar (r=.35) and calories (r=.32) per day were all significantly correlated (p<0.0001). Goal 2: assess the impact of this research based program in established nutrition education activities (extension). The program established with this grant is now part of the CT SNAP-ED program and continues in two early child care centers for two days a week each during the fall and spring academic semesters. During the active grant years, the program reached 4.050 families at 24 early child care centers with eight additional centers added since the end of the data collection period. Extensive evaluations occurred before the program began with monitoring continuing throughout the intervention period. Pierce et al (JNEB 2011; 43:136) tested the conceptual understanding of the curricula, the feasibility of the program, and parents’ acceptance of undergraduate students as the educators for the program. Coleman et al (J. School Health 2013 submitted) assessed the effectiveness of the support provided by 39 classroom teachers in program recruitment and maintenance. Coleman and colleagues are also preparing a manuscript on parental assessment of the program. Goal 3: enhance undergraduate cultural competency and leadership skills through a service-learning program coupled with this research/extension project (education). Because of the intense amount of time, personnel, and funds required to recruit and maintain caregiver participation in the study, we had to prioritize the completion of components of this phase of the project. As the Husky service learning programs were designed to be a three tiered experience with the “Husky Byte” program being on the first level of the second tier, the major jump in cultural competency measured by the instruments proposed occurred at the first level. Instead, we expanded earlier work funded by a Higher Education Challenge grant and tested the change in constructs proposed in a corollary service-learning class (Pierce et al., NACTA.2012;56(3):10-16.)

Publications

  • Type: Journal Articles Status: Submitted Year Published: 2013 Citation: Lora KR, Madura J, Schilling E, Wakefield D, Ferris, AM. Factor structure of the Preschooler Feeding Questionnaire and cross-cultural equivalence in Low-income African-American and Latino caregivers of preschool children. International Journal of Behavioral Nutrition and Physical Activity.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Schilling, E. A., C. Quesada, A. M. Ferris, K. Lora. Latino Caregivers are Less Assertive with Family and Friends about their Childs Beverage Consumption of 100% Fruit Juice. FASEB J, April 9, 2013. 27:841.22.
  • Type: Journal Articles Status: Published Year Published: 2012 Citation: Pierce, M.B., E. Havens, M. Poehlitz, A. M. Ferris. (2012) Evaluation of a Community Nutrition Service-Learning Program: Changes to Student Leadership and Cultural Competence." North American Colleges and Teachers of Agriculture, 56:3, 10-16.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Lora, K., D. B. Wakefield, A. M. Ferris. Caregivers Behavioral Skills Associated with Preschool Children Consumption of Sugar-Sweetened Beverages (SSBs). FASEB J, April 9, 2013. 27:37.3
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Ferris, A. M., D. B. Wakefield, C. Quesada, K. Lora. Reduction in Average Child Consumption of Sugar-Sweetened Beverages without Decrease in Home Inventory. FASEB J, April 9, 2013. 27:37.5.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Coleman, A. S., A. M. Ferris. Fathers Buying Habits Related to Increased Sweetened Beverage Consumption in Preschool Children. FASEB J, April 9, 2013. 27:1063.2.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Quesada, C., E. A. Schilling, A. M. Ferris, K. Lora. Caregivers Knowledge of Sugar-Sweetened Beverages is Associated with Availability of this Type of Beverages in the Home. FASEB J, April 9, 2013. 27:344.4.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Yarbrough, K., E. A. Schilling, A. M. Ferris. Food Security and Supplemental Nutrition Assistance Participation Associated with Home Availability and Preschool Child Consumption of 100% Fruit Juice. FASEB J, April 9, 2013. 27:1054.12.
  • Type: Theses/Dissertations Status: Published Year Published: 2013 Citation: Kuzmeskas (Yarborough), K. Food Security and Supplemental Nutrition Assistance Participation Associated with Home Availability and Preschool Child Consumption of 100% Fruit Juice. Master's thesis as part of Master's in Public Health Degree, University of Connecticut Health Center, 2013.
  • Type: Websites Status: Published Year Published: 2013 Citation: http://www.publichealth.uconn.edu/sweetened-beverage.html
  • Type: Journal Articles Status: Under Review Year Published: 2013 Citation: Coleman, A. S., Wakai, S., Ferris, A.M., (under review, submitted August 2013). An Evaluation of Teacher Assistance in a School-based Health Intervention. Journal of School Health.
  • Type: Theses/Dissertations Status: Published Year Published: 2009 Citation: Wei, S. 2009. At-Home Sugar Sweetened Beverage Consumption in Caretakers and their Children. Master's thesis, Department of Nutritional Sciences, College of Agriculture and Natural Resources, University of Connecticut.


Progress 07/01/11 to 06/30/12

Outputs
OUTPUTS: By June 30, 2012. Enrollment exceeded original projection of 400 caretakers and children. Four hundred and seventy-one caretakers enrolled at baseline (239 intervention and 232 control). The subjects were recruited from 24 pre-school sites. Eighty seven percent of the subjects completed the 10-week intervention and 90% of those who completed the intervention completed the follow-up three months later for an overall retention rate from baseline to three-month follow-up of 78%. Demographics: Control and intervention groups did not differ on caretaker age, gender, ethnicity, education, employment status, WIC and SNAP enrollment, household composition, or household food security. The target caretakers averaged 31 + 7 years of age, were primarily minority (45% African-American, 34% Latino, 17% white, and 5% other). Seventy percent were employed part or full time and 90% attained a high school degree or equivalency. Thirty-five percent were currently enrolled in WIC and 45% in SNAP. Seventy four percent of the households were food secure. Weight status: Twenty-two percent of the caretakers were normal weight, 1% underweight, 34% overweight, and 43% at baseline. Sixty-four percent of the children were normal weight, 3% were underweight, 20% were overweight, and 14% were obese at baseline. More than 60% of children were healthy or normal weight compared to less than 25% of the parents. Sugar-Sweetened Beverage (SSB) intake: Beverage categories included 100% juice, juice drinks, milk, soda, and other beverages such as nutritional supplements. As measured by a home beverage inventory, the most prevalent beverage in the home was juice drinks (27%) followed by 22% from 100% juice, 21% milk, 19% other beverages (coffee, tea, syrups, and nutritional supplements), and 11% soda. Of the total beverage calories consumed by the child, 40% was from milk, 35% 100% juice, 18% juice drinks, 6% other beverages, and 1% from soda. All 2500 food records have been analyzed and quality control is proceeding. Education: Over 50 undergraduate students participated in the class "Husky Byte" or internship associated with this intervention and training and course curriculum retested multiple times to support student participation. The curricula for both the sweetened beverage reduction and sham food safety intervention are being formatted for web access by nutrition and health educators and preschool systems. PARTICIPANTS: Nothing significant to report during this reporting period. TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Program evaluation included perceptions of program effectiveness from parents, teachers, and undergraduate students. The young parents of this intervention preferred the "Husky Byte" students to health professionals, community educators, peers, and teachers as educators and had high confidence in the information provided by students. Teacher participation increased subject recruitment. The project is in the last phases of quality control of data. If effective, this program will decrease SSB consumption in preschool children, provide a sustainable and realistic extension program for community preschools, and increase the number of culturally competent, community-based nutrition education professionals as a result of their participation in this program.

Publications

  • Lora, K., C. Quesada, D. B. Wakefield, A. M. Ferris. (2012). How Does Parental Concern Over Child Weight Influence Parental Feeding Practices Proceeding Annual Meeting of the International Society for Behavioral Nutrition and Physical Activity (ISBNPA). Austin, TX. May, Abstr. 146079)
  • Lora, K., C. Quesada, D. B. Wakefield, A. M. Ferris. (2012). Age of the Caregiver Is Associated with More Desirable Feeding Practices. Proceeding 2012 ISBNPA Pre-Conference Workshop Parenting Measurement: Status and Consensus Reports. May.
  • Coleman, A., K. Lora, A.Ferris (2011). Evaluating parental perceptions of university students as agents of education. American Public Health Association Annual Meeting. Abstr. 248953.
  • Ferris, A. M., K. Lora, C. Quesada, D.B. Wakefield. (2012). Effectiveness of an Information, Motivation, Behavior (IMB)- based theoretical model for reducing sugar sweetened beverage (SSB) consumption in preschool children. Society of Nutrition Education Annual Meeting (AFRI Group), July 15, 2012.
  • Ferris, A.M., D.B. Wakefield, S. Wei, (2012) At-home sweetened beverage consumption in minority, low-income children and caretakers. FASEB J. 26:264.7
  • Lora, K., C. Quesada, D. B. Wakefield, A. M. Ferris. (2012). Association of the Parental Feeding Practices and Type and Home Availability of Sugar-Sweetened Beverages and Fruit Juice of Preschool Children from Low Income Families. FASEB J. 26:1011.1
  • Quesada, C., K. Lora, D.B. Wakefield, A. M. Ferris (2012) Child Characteristics Drive Parental Feeding Practices in African American and Latino Parents. FASEB J. 26:380.2


Progress 07/01/10 to 06/30/11

Outputs
OUTPUTS: Research: By June 30, 2011, we enrolled 353 parents at 18 pre-school sites with retention of 87 of parents to 10 weeks and 79% to three months. The target of 400 from a minimum of 20 sites will be achieved after the summer 2011 phase of the study. In this initial sample, the majority of parents were between 26-35 years of age and were African American and Latino. Latino parents reported Puerto Rico, Dominica Republic, Peru, and Mexico as their country of birth. More African American parents reported having only one adult living in the household and being enrolled in WIC compared to Latino parents (P < .05). More Latino parents completed less than high school education and were married/partnered compared to African American Parents (P <. 05). In the overall sample, most parents were female, reported to be single, had health insurance(Medicaid), were currently enrolled in WIC and employed full time, although over one third were unemployed. More than 60% of children were healthy or normal weight compared to less than 25% of the parents. More Latino children were obese compared to African American children, although this difference was not significant . The majority of the sample was food secure with 19% classified with marginal, 21% with low, and 5% with very low food security status. At baseline, control and intervention parents did not differ in any of the eight factors recorded by the Preschool Feeding Questionnaire (Baughcum et al, 2001). Education: Over 50 undergraduate students participated in the class "Husky Byte" or internship associated with this intervention. Program evaluation included perceptions of program effectiveness from parents, teachers, and undergraduate students. PARTICIPANTS: Nothing significant to report during this reporting period. TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
The major outcome for the year was the completion of 88% of the data collection supporting this intervention. Although, data have been cleaned for most portions of the study, the investigators will refrain from citing conclusions until full power for the analysis is obtained. Separate analyses on the associations of pre-school feeding practices with sugar sweetened beverage (SSBs)consumption noted that higher structure during feeding interactions predicted lower amount of SSBs fed to the child. Latino parents had significantly higher child centric feeding and use of rewards and higher age inappropriate feeding compared to African American parents. The young parents of this intervention preferred the "Husky Byte" students to health professionals, community educators, peers, and teachers as educators and had high confidence in the information provided by the students.

Publications

  • Goodell, L.S., R. Amico, M. Pierce, and A.M. Ferris. (2011) Parental Information, Motivation, and Behavioral Skills Correlate with Child Sweetened Beverage Consumption. Journal of Nutrition Education and Behavior. [E-print ahead of print]. PMID:21636326.
  • Pierce, M.B., K. A. Hudson, K.R. Lora, E.K. Havens, and A.M. Ferris. (2011) The Husky Byte Program Delivering Nutrition Education One Sound Byte at a Time. Journal of Nutrition Education and Behavior, 43:135-6.PMID: 21392715.
  • Lora, K.R., C.Quesada, D. B. Wakefield, and A. M. Ferris (2011) Parental Perception of Child's Weight Affects Child's Feeding Practices FASEB J 25:99.3.
  • Quesada, C., K. R. Lora, D.B. Wakefield, A. M. Ferris. (2011). Latino and African American Parents of Preschool Children Differ in Their Feeding Practices FASEB J 25:781.26


Progress 07/01/09 to 06/30/10

Outputs
OUTPUTS: In the first part of the second year, we conducted a pilot intervention at two schools. The objectives of the pilots were to re-test instruments and procedures in the context of a full intervention, evaluate the parent reactions to the presentations, and test the efficiency of the operational design of the intervention. In addition, messages, activities, and reinforcing gifts were re-evaluated. The major changes made after the pilot were reducing the second follow-up interview from six months to three months because of the difficulty with follow-up if a child left the school or graduated to another program and conducting interview in the home or community site rather than the school. In addition, we refined the retention protocol, brought in a marketing consultant, and tested student fidelity to the protocol when delivering the messages. In January, we inaugurated the full intervention in four additional sites. By June, we had conducted 178 baseline interviews, 80 ten- week interviews. Average retention at 10 weeks was 83%. PARTICIPANTS: M. Pierce Co-PI left the project in October 2009. K. Lora, post doctoral fellow assumed the role of project manager assisted by a new employee, C. Quesada, MPH, RD. Two doctoral students, David Glenn and Ailton Coleman and several special payroll interviewers joined the project. Sites participating in this grant year were Hartford Public School pre-school sites: Wish and Simpson-Waverly Schools; Community Renewal Team sites: Douglas, Locust, and Ritter, as well as Women's League and The Right Place (Salvation Army) pre-school sites. TARGET AUDIENCES: The study is being conducted in Hartford, CT, one of the poorest mid-size cities in the United States. One hundred and eighty-seven poor women from under-represented groups completed the baseline interview. Eighty three per cent completed the follow-up at 10 weeks. The education format for the intervention used interactive boards. Undergraduate students delivered the program when parents picked up their children from daycare. Interactions were under 5 minutes. PROJECT MODIFICATIONS: The major project modification was changing the second follow-up from six months to three months. Once students left the pre-school, follow up was extremely difficult. Very few mothers had a consistent telephone number. Most used pay as you go disposable cell phones. Over 40% had not lived at the same address for one year. Even the three-month follow-up requires extensive detective work to maintain sample size.

Impacts
The major outcome for the year was the development of a stable curriculum with improved graphics and background materials. The boards and the messages were re-ordered and divided into three main themes; portion size, sugar content of 100% fruit juice and juice beverages, and water consumption.

Publications

  • Pierce, M.B., K.A. Hudson, K.R. Lora, E.K. Havens, and A.M. Ferris. 2011. The Husky Byte Program: Delivering Nutrition Education One Sound Byte as a Time. Journal of Nutrition Education and Behavior. In Press 11/8/10.
  • Goodell, L.S., R. Amico, M. Pierce, and A.M. Ferris. 2011. Parental Information, Motivation, and Behavioral Skills Correlate with Child Sweetened Beverage Consumption. Journal of Nutrition Education and Behavior. In Press. 5/25/10.


Progress 07/01/08 to 06/30/09

Outputs
OUTPUTS: In the first year of the project, we hired postdoctoral fellow and staff, revised and re-tested the information, motivation, and behavior questionnaires, identified intervention sites, tested all procedures, ran a pilot at two sites with 13 individuals, and developed the education curriculum for the classes with this project. In the formative data for this project, we learned that parents tend to group drinks as "healthy" and "not healthy" or "drinks that I give my child" or "drinks that I do not give my child and to identify drinks by brand name and not the percent of juice in the drink. In refining our questionnaire, we found the major challenge was to formulate generalized questions. However, neither of the parent categorization schemes strictly follows the definitions of health professionals. We addressed this issue by using pictures of beverages. A card sort of 10 beverages is presented, asking parents to divide the drinks into two categories, "all juice" and "less than all juice," for which we provide the grouping definitions. The results of the card sort form a basis for us to evaluate each parent's understanding of recognized and novel beverages. We also provide picture grouping for questions about drink categories. PARTICIPANTS: The original team proposed in the project (A. Ferris -PI, M. Pierce -Co-PI, and R. Amico, R. Aseltine, and O. Harel - Co-Investigators) remained intact for the year. In addition, we hired K. Lora from the University of Nebraska in 1/09 as a postdoctoral fellow. K. Hudson, a fourth year minority medical student completed her selective with our group and evaluated the parent's perception of the effectiveness of the intervention and undergraduates as deliverers of the information. Our primary site partner for this year was the Capitol Region Education Council in CT. TARGET AUDIENCES: Thirteen female caretakers participated in the pilot. The mean age was 31 with a range of 19-61. Five were African-American, seven Latina, and one was Asian. Seven were single, three married, and three partnered and had on average 12 years of education (9-17 yrs). Seven had been on Supplemental Nutrition Assistance and eight on WIC. All lived in the two poorest zip codes. PROJECT MODIFICATIONS: We replaced the Child Feeding Practices Questionnaire (Anderson et al. Prev Med. 2005;41:521.) proposed in the original submission with the Preschooler Feeding Questionnaire (Baughcum, AE et al. J. Dev. Beh Ped. 2001;6:391) as parents found the language and concepts of the second easier to understand. We had also originally proposed one in-person interview followed by a telephone follow-up for each phase, but found that two in-person interviews improved continued participation.

Impacts
Because of the findings from the qualitative assessment and refinement of data collection protocols and instruments and a pilot testing of the nutrition education curriculum and materials provided to parents and the class for university students, we have improved the following aspects of the program. For the interactive display, we refined the motivational messages, clarified the "take-home" point of each interaction. For students, we increased background knowledge and suggested concrete motivational conversation starters. To increase parent awareness, we increased our proposed time at each site, created a flyer to send home to parents, and prominently displayed the schedule for the program.

Publications

  • Goodell, L.S., Amico, K.R., Pierce, M.B., Ferris, A.M. 2008. An information-motivation-behavioral skills model for child sweetened beverage consumption. FASEB J. (Abstract 678)