Progress 09/01/10 to 08/31/14
Outputs
Target Audience: Target Audience Two Head Start centers were involved: the Eden Head Start Center, which operates 10 classes serving a total of 195 children from Monday through Friday and the Somerset Head Start Center, which runs six classes and serves a total of 115 children from Monday through Friday. Approximately 95% of the children were African Americans, 4% Caucasians, and 1% Hispanic. The Somerset center is the intervention group and the Eden center is designated as the control group. Approximately 30 parents were involved. Effort: In order to cause change in knowledge and actions, the following efforts were implemented. The intervention group had the Eagle books read to them and physical activities conducted for them. The reading was supplemented with gardening and nutritious food demonstrations and preparations. Portion control and plate waste analyses were conducted with the intervention group. The control group read the Eagle books to the preschoolers and conducted physical activities for them. The EFNEP educators reached and provided the parents with eight nutrition education and physical activity sessions. The parents and the preschoolers were exposed to the gardening activities, such as indoor and high tunnel gardening activities. Family nights were organized at the intervention center. These events helped the preschoolers to show their caregivers what they learned from the project. Teachers were trained on the Eagle books series. They understood the contents of the Eagle books, and they were involved in all physical activities. To make the physical activities fun and instructive, the messages in each book was used to create songs that the preschoolers, teachers, and parents clearly enjoyed. Changes/Problems: none What opportunities for training and professional development has the project provided? This project gave the research team the opportunity to train the extension educators and the Head Start staff. Additionally, dietetic interns and students enrolled in undergrad nutrition program were trained on plate waste management methodology, data collection and analysis. Head Start staff had the opportunity to enhance their knowledge in gardening and particularly in high tunnel activities. How have the results been disseminated to communities of interest? 1-Four (4) CDs were developed using the messages in Eagle Books series. 2-A video was created and shared with the community at the Ag-field day at the University of Maryland (September, 2014). It was also shared with the senior administrators at UMES. 3- The research team is planning to share this video with USDA in January 2015. 4-The results will be shared with Zhejiang University (food science and nutrition department, and the school of public / department of disease prevention (December 15- 25, 2014). The results of this project were also shared at the following conferences and seminar: 1- The World Diabetes Congress, Dubai, UAE, December 04-08, 2011. 2- The 20th International Congress of Nutrition; The International Union of Nutritional Sciences (IUNS). Granada, Spain. 15-20th September 2013. 3-The weekly School of Agricultural and Natural Sciences seminar at the University of Maryland Eastern Shore. October 30, 2013. 4- The Obesity in Children and Adults: Translating Molecular Mechanisms To the Mainstream, Baltimore, Maryland November 13,2013. What do you plan to do during the next reporting period to accomplish the goals? This reporting period is the last one for this funding opportunity. The next step will be to replicate the project in three Head Start centers with larger demographics.
Impacts
What was accomplished under these goals?
ACCOMPLISHMENTS Approximately 100 children learned and shared positive behaviors related to healthy lifestyle. They understood that food comes from the earth and is sold in grocery stores. Approxumately 60 parents learned positive behaviors from EFNEP programs and from their children; they started applying better food decision strategies while feeding their families. Teachers learned how to be better role model to the children during lunch time by eating more fresh and raw vegetables. Outcomes/Impacts: During the fiscal year 2010-2014 we observed the following: A change in knowledge The preschoolers increased their knowledge of the importance of fruit and vegetable consumption and a healthy lifestyle in general. They continued to recognize the fruits and vegetables by their colors and to relate them to their specific name and to verbalize the consequences of eating too much sugar or too much salt and drinking too much soda as well as the benefit of eating fruits and vegetables, drinking water, and exercising the body. Preschoolers increased their knowledge of food origins through gardening, especially in the high tunnel. All these results were also observed during the fiscal year 2013-2014. A change in actions: The data analysis indicated that fruits and raw vegetables were being accepted and consumed not only by the preschoolers, but also by their caregivers and sublimes. Based on the food consumption percentage calculated as the average consumption of each food over its initial weight, the top four favorites were as follows: Clementine 61.45%; Strawberry 37.70%; Corn 15.92%; Broccoli 25.29%. In addition, more than 50% of the children increased their initial consumption by more than 50%. These results showed that the preschoolers are not only familiar with a variety of fruits and vegetables, but they also desire to consume them. Some of the preschoolers shared the messages with their parents/caregivers at home and some families started eating more fruits and vegetables as indicated in this statement: “The program was very informative to all of us, me and my children. If one or both of my boys catch me drinking an occasional soda, they would tell me not to drink too much because there’s too much sugar. Nyeisha (Parent).” Teachers also mentioned some changed in their eating habits in terms of fruit and vegetable consumption. A teacher said: “I have never tried raw broccoli before this program. Now I love it.” However, the statistical analysis showed a difference in the consumption of fruits and vegetables by classroom. This means that the teachers may influence the preschoolers' food consumption. These results showed that we reached the goal of this project, which was to help caregivers to take action through their children. In order to confirm the previous results, more data collection were collected during the fiscal year 2013-2014. The grant was supposed to end in August 2012. However, we received an extension with no cost, which allows us to conduct new data collection during the fiscal year 2013-2014. At the end of the first semester of the school year 2013-2014, the preliminary analysis of this new set of data confirmed the same results obtained the previous year. The final data collection will be finalized during the second semester of the 2013-2014 school year. Overall, the results indicated that approximately more than 50% of the preschoolers increased their consumption of fresh fruits and vegetables consumption by at least 50% over the school -year period. Approximately 80% of the preschoolers shared positive behaviors message at home and at school. A focus group with the parents also indicated the parents/caregivers’ interest in the project continued to increase. The external evaluator met with the advisory committee which included Head Start administrators, coordinators, teachers, other caregivers, and the project team. The report of this meeting indicated that Head Start staff and caregivers are willing to continue the project. They all agreed on developing a strategic plan to allow the sustainability of the project.
Publications
- Type:
Conference Papers and Presentations
Status:
Under Review
Year Published:
2014
Citation:
Three manuscripts are being prepared for submission.
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Progress 09/01/12 to 08/31/13
Outputs
Target Audience: Target Audiences: Two Head Start centers were involved: the Eden Head Start Center, which operates 10 classes serving a total of 195 children from Monday through Friday and the Somerset Head Start Center, which runs six classes and serves a total of 115 children from Monday through Friday. Approximately 95% of the children were African Americans, 4% Caucasians, and 1% Hispanic. The Somerset center is the intervention group and the Eden center is designated as the control group. Approximately 30 parents were involved. Effort: In order to cause change in knowledge and actions, the following efforts were implemented. The intervention group had the Eagle books read to them and physical activities conducted for them. The reading was supplemented with gardening and nutritious food demonstrations and preparations. Portion control and plate waste analyses were conducted with the intervention group. The control group read the Eagle books to the preschoolers and conducted physical activities for them. The EFNEP educators reached and provided the parents with eight nutrition education and physical activity sessions. The parents and the preschoolers were exposed to the gardening activities, such as indoor and high tunnel gardening activities. Family nights were organized at the intervention center. These events helped the preschoolers to show their caregivers what they learned from the project. Teachers were trained on the Eagle books series. They understood the contents of the Eagle books, and they were involved in all physical activities. To make the physical activities fun and instructive, the messages in each book was used to create songs that the preschoolers, teachers, and parents clearly enjoyed. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided? The preschool teachers were trainded on the Eagle books curriculum, indoor gardening skills, and high tunnel gardening skills. The cafeteria staff was trained on the handling of the fresh foods. How have the results been disseminated to communities of interest? DISSEMINATION The results of this project were shared at the following conferences and seminar: 1- The World Diabetes Congress, Dubai, UAE, December 04-08, 2011. 2- The 20th International Congress of Nutrition; The International Union of Nutritional Sciences (IUNS). Granada, Spain. 15-20th September 2013. 3-The weekly School of Agricultural and Natural Sciences seminar at the University of Maryland Eastern Shore. October 30, 2013. 4- The Obesity in Children and Adults: Translating Molecular Mechanisms To the Mainstream, Baltimore, Maryland November 13,2013 5-Two manuscripts are being prepared for submission. What do you plan to do during the next reporting period to accomplish the goals? These results showed that we reached the goal of this project, which was to help caregivers to take action through their children. More data collection is needed in the fiscal year 2013-2014 in order to confirm the results obtained during the fiscal year 2010-2012. The first group of students will leave the center at the end of the school year 2013. The grant was supposed to end in August 2012. However, we received an extension with no cost, which allows us to conduct a new data collection at princess Anne. We will collect more data with another group of preschoolers from 2013-2014 and implement the rest of the intervention with the control group during the same time period, 2013-2014.
Impacts
What was accomplished under these goals?
Outcomes/Impacts: During the fiscal year 2012-2013 we observed the following: A change in knowledge The preschoolers increased their knowledge of the importance of fruit and vegetable consumption and a healthy lifestyle in general. They continued to recognize the fruits and vegetables by their colors and to relate them to their specific name and to verbalize the consequences of eating too much sugar or too much salt and drinking too much soda as well as the benefit of eating fruits and vegetables, drinking water, and exercising the body. Preschoolers increased their knowledge of food origins through gardening, especially in the high tunnel. A change in actions: The data analysis indicated that fruits and raw vegetables were being accepted and consumed not only by the preschoolers, but also by their caregivers and sublimes. Based on the food consumption percentage calculated as the average consumption of each food over its initial weight, the top four favorites were as follows: Clementine 61.45%; Strawberry 37.70%; Corn 15.92%; Broccoli 25.29%. In addition, more than 50% of the children increased their initial consumption by more than 50%. These results showed that the preschoolers are not only familiar with a variety of fruits and vegetables, but they also desire to consume them. Some of the preschoolers shared the messages with their parents/caregivers at home and some families started eating more fruits and vegetables as indicated in this statement: “The program was very informative to both of us, me and my children. If one or both of my boys catch me drinking an occasional soda, they would tell me not to drink too much because there’s too much sugar. Nyeisha (Parent).” Teachers also mentioned some changed in their eating habits in terms of fruit and vegetable consumption. A teacher said: “I have never tried raw broccoli before this program. Now I love it.” However, the statistical analysis showed a difference in the consumption of fruits and vegetables by classroom. This means that the teachers may influence the preschoolers' food consumption.
Publications
- Type:
Other
Status:
Published
Year Published:
2011
Citation:
Publications/Conference papers and presentations
1-V Zoumenou, M Schwarz 2011: Enhancing diabetes prevention across culture: teaching black children using the Eagle Book series and gardening activities in Maryland Lower Eastern Shore Area. World Diabetes Congress, Dubai, UAE, December 04-08,2011.
2- V Zoumenou, L DaSilva, T Gong 2013: Three Year-Old Head Start Preschoolers Learned And Shared Positive Behaviors With Their Caregivers At School And At Home. 20th International Congress of Nutrition; The International Union of Nutritional Sciences (IUNS). Granada Spain. 15-20th September 2013.
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Progress 09/01/11 to 08/31/12
Outputs
OUTPUTS: Outputs: The Head Start: Jump Start on Healthy Lifestyle Program in Somerset County, Maryland aims to increase each child's consumption of fresh fruits and vegetables and reduce the intake of solid fats and added sugars. These measures, along with encouraging physical activity, will help prevent childhood obesity. During the fiscal year 2011-2012, two Head Start Centers were involved. Eden Head Start Center, which operates 10 classes serving a total of 195 children from Monday through Friday, and Somerset Head Start Center, which runs six classes and serves a total of 115 children from Monday through Friday. The Somerset center is the intervention group and the Eden center is designated as the control group. The intervention group has the Eagle books read to them and conducts physical activities for them. The reading is supplemented with gardening and nutritious food demonstrations and preparations. Portion control and plate waste analysis is conducted with the intervention group. The control group reads the Eagle books to the preschoolers and conducts physical activities for them. An external evaluation was conducted at both centers. Interviews were conducted with project staff as well as parents and teachers using three questions: Project staff: What are the three most important things you expect preschoolers to learn from the project Head Start program staff: Have you observed any change in preschoolers and parents that you attribute to the project Parents of Preschoolers: Has there been any difference in what your preschooler talks about at home The results of the interviews indicated changes in knowledge and in actions were observed among teachers and preschoolers in the intervention group. The results also indicated that the preschoolers were able to talk about what they learned through the project and asked their parents or caregivers for more fruits and vegetables since the program has started. Project staff is very committed to helping make the project a very successful one. They are trained, competent, consistent with implementation of the project, and very professional. Preschoolers recognize project staff and associate the contents of project and activities with them. In the control group: Preschoolers in the control were only shown real samples during the reading session. No food demonstrations were offered. However, parents actually know their preschoolers are reading some books with fruits and vegetables because the children mention those fruits and vegetables at home. Teachers in the school understood the project and the contents of the Eagle books. They are involved in the physical activities with the preschoolers. They understood the value of the project. The rest of the intervention should be given to the control group in the project's lifetime to strengthen the project as a model for all Head Start centers and Childcare centers in the Lower Eastern Shore of Maryland. However, the project will end in August 2012. More time is needed to implement the intervention with the control group. Statistical Analysis: The data collected during the fiscal year 2011-2012 was also analyzed in collaboration with a statistician. PARTICIPANTS: Individuals who worked on the project: PI Dr. Virginie Zoumenou supervised all the activities, helped with the staff training and with the data analysis. Co-PI: Dr. Ligia Dasilva helped with the data collection, data analysis, and assisted the PI Project Coordinator and EFNEP educator : Dionne Ray coordinated all the activites and helped with the reading and data collection. project assistant and EFNEP Coordinator: Nakisha Johnson helped with the reading and data collection Student musician: David Karigo: Created the lyrics and the music. Dietetics interns at UMES: helped with the reading and data collection. Other UMES students: helped with the reading and data collection. Statistcian: Dr. Tao Gong helped with data analysis. Dr. Tom Handwerker: Faculty member in the Department of Agriculture: helped with the high tunnel gardening. A farmer: helped with the teaching and the maintenance of the high tunnel A master garner" helped with the indoor gardening. Partner Organizations Head Start Shore Up inc. facilitated the activities in the centers and the meetings with the parents. Cooperative Extension Small farm program team facilitated the construction of the high tunnel. TARGET AUDIENCES: Two Head Start Centers were involved. Eden Head Start Center, which operates 10 classes serving a total of 195 children from Monday through Friday, and Somerset Head Start Center, which runs six classes and serves a total of 115 children from Monday through Friday. The Somerset center is the intervention group and the Eden center is designated as the control group. Approximately 30 parents were involved. In order to cause change in knowledge and actions the following efforts were implemented:The intervention group has the Eagle books read to them and conducts physical activities for them. The reading is supplemented with gardening and nutritious food demonstrations and preparations. Portion control and plate waste analysis was conducted with the intervention group. The control group reads the Eagle books to the preschoolers and conducts physical activities for them. The EFNEP educators reach and provide the parents with 8 nutrition education and physical activities sessions. The parents and the preschoolers were exposed to the gardening activities such as indoor and high tunnel gardening activities. Family nights were organized at the intervention center. These events helped the preschoolers to show their caregivers what they learned from the project. Teachers were trained on the Eagle Books. They understood the contents of the Eagle Books and they were involved in all physical activities. To make the physical activities fun and instructive, the messages in each books was used to create songs that the preschoolers, teachers, and parents clearly enjoyed. PROJECT MODIFICATIONS: In addition to the indoor gardening, the project added the construction of a high tunnel to increase the exposure of the preschoolers and their parents to the gardening component. The construction of the high tunnel was financed by the Extension Small Farm program who understood the values of this project.
Impacts
Outcomes/Impacts During the fiscal year 2011-2012: A change in knowledge As mentioned by the External Evaluator, preschoolers increased their knowledge of the importance of fruit and vegetable consumption and a healthy lifestyle in general. The preschoolers were able to recognize the fruits and vegetables by their colors and to relate them to their specific name. They can verbalize the consequences of eating too much sugar, too much salt, or too much soda, and the benefit of eating fruits and vegetables, drinking water, and exercising the body. Preschoolers increased their knowledge of food origins through gardening. A change in actions: The data analysis indicated that fruits and raw vegetables were being accepted and consumed not only by the preschoolers, but also by their caregivers and sublimes (see above the external evaluation report and below the statistical analysis). Based on the food consumption percentage calculated as the average consumption of each food over its initial weight, the first top five are as follows: strawberries 72 percent, clementines 67 percent, spinach 62 percent, cucumber 62 percent, and broccoli 58 percent. These results showed that preschoolers accepted and consumed raw broccoli and spinach. Some of the preschoolers shared the messages with their parents/caregivers at home and some families started eating more fruits and vegetables. Teachers also mentioned some changed in their eating habits in term of fruit and vegetable consumption. However, the statistical analysis showed a difference in the consumption of fruits and vegetables by classroom. The family style is used during lunch at Head Start. This means that the teachers may influence the preschoolers' food consumption. A sociologist or an anthropologist may help to better understand the teachers' influence on the preschoolers' consumption. These results showed that we are reaching the goal of this project, which was to help caregivers to take action though their children. More data collection is needed in order to confirm the results obtained during the fiscal year 2011-2012. The first group of students will leave the center at the end of the school year 2013. It will be interesting to collect more data with another group of preschoolers from 2013-2015 and implement the rest of intervention with the control group during the same time period, 2013-2015. In addition, as mentioned above, a better understanding of the teachers' influence is needed. Two more years of data collection will help to confirm the results and to replicate the program in several Head Start Centers in Maryland and if possible nationwide. The grant is supposed to end in August 2012. The Project team is planning to submit a renewal proposal on January 2013 for two more years 2013-2015.
Publications
- ABSTRACTS: V Zoumenou, M Schwarz 2011: Enhancing diabetes prevention across culture: teaching black children using the Eagle Book series and gardening activities in Maryland Lower Eastern Shore Area. World Diabetes Congress, Dubai, UAE, December 04-08,2011.
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Progress 09/01/10 to 08/31/11
Outputs
OUTPUTS: Activities The Head Start: Jump Start on Healthy Lifestyle Program in Somerset County, Maryland aims to increase each child's consumption of fresh fruits and vegetables and to reduce each child's intake of solid fats and added sugars. These measures, along with encouraging physical activity, will help prevent childhood obesity. The foundation of the program began with the solid training of the extension educators and undergraduate students to assure proper facilitation of the program. The Head Start cafeteria staff and teachers were also trained for their respective duties (i.e., curriculum and related activities and food preparation). With the assistance of trained extension educators, Head Start teachers taught the Eagle Book series, promoting healthy food choices and physical activity in preschool children. Fresh fruit and vegetables were introduced in the preschoolers' menus. Plate wastes were measured after breakfast and lunch. Project Investigators also introduced a new physical activity and musical curriculum to encourage fruit and vegetable consumption. A pre and post test evaluated behavior change in Head Start preschoolers. The questions were first tested for validity and reliability before implementation. To ensure the preschoolers' and teachers' exposure to fruit and vegetables, a master gardener introduced the indoor gardening concept in each classroom. Teachers were trained by the master gardener. Each semester the master gardener will ensure that each classroom will grow some produce. To ensure accurate outreach, focus groups were held with Head Start parents. The project awarded adults an opportunity to make behavioral changes with their children. Focus groups were held to identify parents' challenges with feeding their preschoolers fruit and vegetables. Cooking demonstrations, nutrition lessons, and physical activity took place with the adults at their monthly parent meetings. Pre and post tests were also taken to evaluate the health knowledge of parents. Two project team meetings were held in Spring 2011 before the beginning of the activities and in Fall 2011 after the first external evaluation. Events and Services: An external consultant trained Extension Educators on plate waste weighing. This ensured the accuracy of data collection. An external evaluator observed each step of the process (teaching, food weighing, kitchen activity, class activities, physical activity, and a musical component). A project team meeting was held with the external evaluator, principle investigators, master gardener, and the project statistician to discuss project challenges and future implementation strategies. Products: Posters and songs were created to reinforce the messages delivered during the teaching sessions and to make physical activity fun. Dissemination: The curriculum focuses on childhood obesity and diabetes prevention. The preliminary data collected from curriculum adoption by the teachers were summarized in an abstract, which was accepted for presentation at the World Diabetes Congress in Dubai UAE December 4-8, 2011. PARTICIPANTS: The PI: Dr Virginie Zoumenou, Extension Nutrition Assistant/EFNEP Coordinator has spent 2% of her time on this project for $1,320/per year with fringe benefits 32% of $422/year and has been involved in all phases, has been responsible for writing all protocols and ensuring that they are followed. The Co-PI: Dr. Missale Kumelachew has spent 5% of her time for a summer allocation of $650 with fringe benefits 8% of $52/year to work closely with the PI to identify and/or review all educational materials appropriate to each target audience and to summarize the findings. The Program Assistant has been hired for 20 hours/week at $13.00/hour to be involved in all phases, be responsible for coordinating all protocols and ensuring that they are followed. The PA has worked with the external evaluator and the computer science department and the educators as needed. The PA has worked closely with the PI on writing and submitting the annual USDA reports and abstract for publications. An assistant has been hired to help with all components of the program at 20 hours per week at $13.00/hour. Viginia Rosencranz, the master gardener, has provided classroom instruction on indoor gardening with no monetary payment for her services. Dr. Eunice Bonsi, the external evaluator from Tuskegee Institute, has conducted the first year evaluation. She has been involved in designing and monitoring the project evaluation throughout the year. Four undergraduate students have been hired at $8.50/hour for work study on this project for hands-on experience in data entry, analysis and evaluation. Data collected will be entered into a computer system and analyzed by these students. It will build and enhance the students' capacity in their future work. We have partnered with Head Start Child Care Centers under the structure of SHORE UP! Inc. which is a private, non-profit Community Action Partnership located in Salisbury, on Maryland's Lower Eastern Shore. Formed in 1965, SHORE UP! has been serving low-income and disadvantaged persons on the Eastern Shore for over 45 years. Collaborative efforts have taken place to strengthen food and agricultural sciences and education at the 1890 Institutions by strengthening the ties between Extension/outreach to the community at large and experiential learning through integration and enhancement of Head Start program and three academic programs (food/nutrition and child development) within the Human Ecology Department, Agricultural Department, and Math and Computer Science Department. Dr. Avinash Tope from Kentucky State University offered a two day training for educators and students involved in the project on plate waste data collection. Training has been provided for the Head Start teachers on the Eagle Book Series by the P.I. College students have been trained as well on curriculum implementation. TARGET AUDIENCES: Our target audience is Head Start Preschoolers, teachers, cafeteria staff, and families who qualify for the Head Start programs. In order to qualify, you must be a resident of the State of Maryland, a parent or primary caregiver responsible for a child who is too young for public school, and your household's annual income before taxes must not exceed the federal poverty level of $10,830 if one person lives in the household; $14,570 for two people; $18,310 for three; $22,050 for four; $25,790 for five; $29,530 for six; $33,270 for seven; $37,010 for eight; and for larger households add $3,740 for each additional person in the home. Monthly workshops have been offered to parents and guardians of the Head Start Students. Parents have improved their perceived benefits and readiness as it relates to consuming fruits and vegetables measured using EFNEP food behavior checklist survey adapted from Townsend and Keiser (2003 checklist). Preschoolers have been taught the Eagle Books curriculum and have been exposed to indoor gardening. Fresh fruits and vegetable have been introduced in their daily menu. Children's awareness of the importance of eating fresh fruits and vegetables has been assessed based on Pre and Post Surveys taken before and after curriculum instruction. PROJECT MODIFICATIONS: It took quite some time to have access to the Visa debit card for purchases due to administrative issues at UMES. As a result, we were not able to start implementing the menu changes as scheduled. Once the card was received, and money was distributed, the program was able to start on August 22, 2011; however, we were able to finish the data analysis from the pilot study. The collaborating partner: Dr. Thessalenuere Hinnant-Bernard, Family Scientist faculty, left UMES to accept a position in another institution. The PI and the Co-PI conducted the activities assigned previously to Dr. Hinnant-Bernard.
Impacts
Outcomes/impacts: knowledge, actions, or conditions Approximately 100 youth from Somerset County Head Start on the Lower Eastern Shore of Delaware participated in the project from February 2010 to Fall 2011. Six teachers, 6 undergraduate students, and 2 extension educators were also trained. Based on the teachers' advices, education materials were developed to reinforce the teaching process. The team collected preliminary data, which were analyzed. This project is continuously collecting data. An abstract is being drafted related to the preliminary results on the teachers' knowledge and their adoption of the new curriculum, the Eagle Books series, originally developed for Native Americans. Approximately 25 adults participated in the project from February 2010- Fall 2011. This allowed more parents to connect with the project. Focus group data and pre and post test data are currently being analyzed.
Publications
- Publication ABSTRACT: V. Zoumenou, M. Schwarz 2011: Enhancing diabetes prevention across culture: teaching black children using the eagle books series and gardening activities in Maryland Lower Eastern Shore Area. World Diabetes Congress, Dubai, UAE, December 04-08, 2011.
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